长效GnRH激动剂与GnRH拮抗剂促排卵方案在反复种植失败患者中的临床应用  

Clinical application of depot GnRH agonist protocol and GnRH antagonist protocol in patients with repeated implantation failure

作　　者：李婷婷[1] 陈攀宇[1] 刘晓娉 杨星[1] 王艳芳[1] 梁晓燕[1] 黄睿[1] LI Ting-ting;CHEN Pan-yu;LIU Xiao-pin;YANG Xing;WANG Yan-fang;LIANG Xiao-yan;HUANG Rui(Reproductive Medicine Center,The Sixth Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510655)

机构地区：[1]中山大学附属第六医院生殖医学中心,广州510655

出　　处：《生殖医学杂志》2023年第5期652-658,共7页Journal of Reproductive Medicine

基　　金：广东省自然科学基金项目(2019A1515011764)。

摘　　要：目的 比较卵泡期长效促性腺激素释放激素(GnRH)激动剂方案和GnRH拮抗剂方案应用于反复种植失败(RIF)患者的临床效果。方法 回顾性分析2017年6月至2020年3月在中山大学附属第六医院生殖医学中心行体外受精/卵胞浆内单精子注射(IVF/ICSI)治疗的RIF患者的临床资料。根据促排卵方案进行分组,并通过倾向性评分1∶1匹配选择数据,最终纳入594例患者,长效激动剂组(采用长效GnRH激动剂方案促排卵)297例,拮抗剂组(采用GnRH拮抗剂方案促排卵)297例。比较两组患者的一般资料、促排卵及胚胎发育情况、鲜胚移植及冻融胚胎移植妊娠结局。结果 两组患者的年龄、不孕年限、基础激素水平等一般资料比较均无显著性差异(P>0.05)。拮抗剂组HCG日LH水平显著高于长效激动剂组(P<0.05),HCG日子宫内膜厚度、Gn总量、Gn天数、获卵数则显著低于长效激动剂组(P<0.05)。长效激动剂组新鲜周期的临床妊娠率、活产率显著高于拮抗剂组(P<0.05),两组患者冷冻周期的妊娠结局无显著性差异(P>0.05);但长效激动剂组的累计活产率显著高于拮抗剂组(P<0.05)。结论 卵泡期长效激动剂方案促排卵后行新鲜周期移植的助孕策略可以显著改善RIF患者的妊娠结局,值得优先考虑。Objective:To compare the clinical outcomes between the depot GnRH agonist protocol and the GnRH antagonist protocol during follicular phase in patients with repeated implantation failure(RIF).Methods:The clinical data of the RIF patients who received IVF/ICSI treatment in our reproductive medicine center from Jun.2017 to Mar.2020 were retrospectively analyzed.According to the different ovarian stimulation protocols to classify the patients into two groups,and using SPSS software to analyze the data by propensity score 1∶1 matching selection,finally 594 patients were included in the study.Among them,297 patients were treated with the depot GnRH agonist protocol in the depot agonist group and 297 patients were treated with the GnRH antagonist protocol in the antagonist group.The general information,ovulation induction and embryo development,pregnancy outcome of fresh embryo transfer and frozen-thawed embryo transfer were compared between two groups.Results:There was no significant difference in general data such as age,infertile years,basic hormone level between the two groups(P>0.05).The LH level on HCG day in antagonist group was significantly higher than that in depot agonist group(P<0.05).The duration and the dosage of Gn used and the number of oocytes retrieved in the antagonist protocol group were significant less than those in the depot agonist group(P<0.05).The clinical pregnancy rate and live birth rate in the fresh embryo transfer cycles of dept agonist group were significantly higher than those in the antagonist group(P<0.05).There was no significant difference in pregnancy outcome in the frozen-thawed embryo transfer cycles between the two groups(P>0.05),but the cumulative live rate of the depot agonist group was significantly higher than that of the antagonist group(P<0.05).Conclusions:Fresh embryo transplantation after ovulation induction with depot GnRH agonist protocol in follicular phase can significantly improve the pregnancy outcome of patients with RIF,which is worthy of priority consideration

关 键 词：反复种植失败 卵巢刺激 长效促性腺激素释放激素激动剂 促性腺激素释放激素拮抗剂 累计活产率 

分 类 号：R711.6[医药卫生—妇产科学]