避孕药过渡超长方案在中重度子宫内膜异位症患者体外受精-胚胎移植中的应用

Application of the Contraceptives Transition Protocol on Moderate or Severe Endometriosis Patients in in vitro Fertilization-Embryo Transfer

目的:探讨经典超长方案与避孕药过渡超长方案对中重度子宫内膜异位症(EMs)患者体外受精-胚胎移植(IVF-ET)中黄体生成激素(LH)水平及妊娠结局的影响.方法:将69例(69个周期)经长效促性腺激素释放激素激动剂(GnRHa)预治疗3个月后,按照促性腺激素(Gn)启动方式不同分为2组.经典超长方案组(对照组,27个周期):末次GnRHa注射后25～28 d动态测定子宫内膜厚度≤5 mm、血清LH＜3 U/L、雌二醇(E2)≤35 ng/L,卵泡刺激素(FSH)≤5 U/L后启动Gn.口服避孕药过渡组(OC组,42个周期):末次GnRHa注射后28 d起开始每日服短效口服避孕药1片,共21 d,第17天注射GnRHa(达菲林)1.25～1.88 mg,14d后降调节满意启动Gn.比较2组IVF结局.结果:OC组胚胎种植率、临床妊娠率高于对照组(x2=5.518,P=0.019;x2=4.010,P=0.045).结论:EMs患者经GnRHa预治疗后应用避孕药过渡方案便于把握Gn启动时间,延迟Gn的启动可缓解GnRHa对垂体的过度抑制,获得更好的妊娠结局.

Objective: To compare the level of luteinizing hormone and the outcome of in vitro fertilization-embryo transfer(IVF-ET)conducted with prolonged protocol and long protocol on infertile patients with moderate or severe endometriosis.Methods:A retrospective analysis was performed.Those 69 infertile patients(69 cycles)with moderate or severe endometriosis were treated with long-term gonadotropin-releasing hormone agonis(t GnRHa) down-regulation for 3 months following IVF-ET treatment.Those patients were divided into 2 groups based on different start-time of the controlled ovarian hyperstimulation(COH)protocol,27 patients were in the general ultra-long-protocol group(control group)who received Gn treatment on the 28th day after the last injection day;42 patients were in the contraceptives transition protocol group(OC group)who received oral contraceptives 1 tablet per day on the 28th day after the last injection day and injected GnRHa(Diphereline)on the 17th day.All patients received gonadotropin(Gn)treatment 14 days after the GnRHa 1.251.88 mg injection.Results:The OC group had significantly higher implantation rate and clinical pregnancy rate than control group(χ2=5.518,P=0.019;χ2=4.010,P=0.045).Conclusions:The controlled ovarian hyperstimulation applied with contraceptives transition long protocol after GnRHa down-regualtion is a better way for those patients with emdometriosis.It is easy to master the start time of Gn and alleviate the excessive inhibition of GnRHa for pituitary.This method can obtain good pregnancy outcome.