摘要
目的：比较促性腺激素释放激素激动剂（GnRH—α）长短方案在体外受精-胚胎移植（IVF—ET）中的效果。方法：2002年2月～2004年5月行IVF和单精子卵胞浆注射（ICSI）患者105名．其中长方案组65名于促性腺激素（Gn）治疗周期的前个黄体中期使用GnRH—α（0．9mg／d）．垂体完全降调后于月经d3开始应用Gn；短方案组40名于月经d3同时应用GnRH—α（0．9mg／d）和Gn。2组均在优势卵泡达18mm当晚肌注入绒毛膜促性腺激素（hCG）．36h后取卵行IVF或ICSI。结果：短方案组Gn用量明显减少[（31．4＋12．1）VS（39．5＋16．2）支．P〈0．013．用药时间缩短[（11．4±1．5）VS（12．7＋2．0）d，P〈0．013；长方案组在经降调节后Gn他用前（启动日）血清促卵泡素（FSH）、黄体生成素（LH）、雌二醇（E2）水平明显低于短方案组[（4．5＋2．0）VS（6．4±2．0）IU／L．（3．2±1．9）VS（4．8＋2．3）IU／L，（121．8＋81．0）VS（182．8±64．2）pmol／L．P〈0．01]；hCG注射日患者血清LH、E2、黄体酮（P）水平及M11卵子数、卵子受精数、卵裂嫩和优质胚胎数．2组差异均无显著性（P〉0．05）；但长方案组患者妊娠率高于短方案组（30．8％VS12．5%），P〈0．05）。结论：GnRH—α短方案能获得与长方案相同的控制性超排卵效果，且Gn用量明显减少．但临床妊娠率低于长方案。
Objective: To compare the effect of gonadotropin-releasing hormone agonists(GnRH-a) used in either long or short protocols as part of in vitro Fertilization(IVF) or intracytoplasmic sperm injection(ICSI) treatment.Methods: Sixty-five couples(long regimen group) and forty couples(short regimen group) were provoded with IVF or ICSI and were retrospectively analyses.In the GnRH-a long regimen group,GnRH-a was given by nasal spray 0.9 mg/day at the start of the midluteal phase(d21)of the previous gonadotropin(Gn)cycle.After pituitary desensitization the patient was administrated Gn on the third day of the menstrual cycle.While in the GnRH-a short regimen group,GnRH-a(nasal spray 0.9 mg/day)and Gn were taken on the third day of the menstrual cycle.The human chorionic gonadotrophin(hCG) was used when ≥3 follicles had a mean diameter of ≥18 mm in both the two kinds of the protocol.Oocytes were retrieved 36 hours after hCG injection via transvaginal ultrasounography,then IVF/ICSI were performed as routine.Results: Gn ampoules were fewer and stimulation period were shorter in the short regimen group compared with long regimen group [(31.4± 12.1) vs(39.5± 16.2) Amps,P<0.01,(11.4± 1.5)vs(12.7± 2.0)d,P<0.01,respectively].Plasma follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2) levels on the day of Gn starting were lower in the long regimen group than the short regimen group [(4.5 ±2.0) vs(6.4 ±2.0) IU/L,(3.2± 1.9) vs(4.8 ±2.3) IU/L,(121.8± 81.0) vs(182.8 ±64.2)pmol/L,P<0.01].And there were no significantly statistically differences between the two groups in the serum LH,E_2,Progesterone(P) of the injection hCG day and numbers of eggs collected,metaphase of second meiosis oocytes,fertilized oocytes,fertilized oocytes,cleaved embryos,superior quality embryos.The pregnancy rate(PR) was significantly higher in long regimen group compared with short regimen group(PR 30.8% vs 12.5%,P<0.05).Conclusion: The GnRH-a long protocols and short protocols have a similar effects on controlled ovarian hyperstimulation for in vitro fertilization.The patients who underwent short regiment required fewer ampoules of Gn and shorter period of ovarian stimulation than the patients who accepted the long regiment.But the clinical pregnancy rate is significantly higher with the long protocols than with the short protocols.
