在体外受精周期中应用促性腺激素释放激素拮抗剂方案的临床分析

Clinical application of gonadotropin-releasing hormone antagonist in Chinese women undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer

目的分析体外受精-胚胎移植周期中应用促性腺激素释放激素(GnRH)拮抗剂方案患者的临床特征和治疗结局。方法回顾性分析54个GnRH拮抗剂起始周期和52个移植周期患者的年龄、GnRH使用天数和剂量、启用GnRH拮抗剂的时机和天数、用拮抗剂日和hCG日血清E2和LH水平、获卵数、临床妊娠率等,与同期长方案GnRH激动剂组临床妊娠率进行比较。结果52个拮抗剂方案移植周期和同期126个激动剂长方案移植周期的临床妊娠率分别为46.2%和56.8%。拮抗剂组患者年龄(35.7±3.8)岁,应用Gn时间(8.5±1.6)d,应用拮抗剂(4.5±1.1)d,hCG日E2水平为(1616.7±721.1)pg/ml,取卵数7.4±4.6个,移植胚胎数(2.4±0.6)个,着床率27.7%。其中≤37岁组34个周期,≥38岁组18个移植周期,临床妊娠率分别为55.9%和27.8%。固定方案组于应用GnRH的第4￣5天启动拮抗剂,36个移植周期的临床妊娠率为50.0%,机动方案组于卵泡12￣15mm时(应用GnRH的第6￣9天)启动拮抗剂,16个移植周期的临床妊娠率为37.5%。与激动剂长方案组相比,拮抗剂方案组中患者年龄较大、GnRH用药时间较短、获卵数较少、血清E2峰值较低,有统计学差异(P<0.01);临床妊娠率稍低,无统计学差异(P>0.05)。结论在体外受精-胚胎移植周期治疗中应用GnRH拮抗剂,是一种方便、快速、有效的治疗选择,能获得满意的临床结局。

Objective To analyze the clinical characteristics and cycle outcome of Chinese women with gonadotropin-releasing hormone （GnRH） antagonist treatment during controlled ovarian hyperstimulation （COH） for in vitro fertilization and embryo transfer （IVF-ET）. Methods A retrospective review was conducted in patients who completed 54 consecutive cycles of IVF-ET with GnRI-I antagonist treatment for luteinizing hormone （LH） surge prevention. Descriptive statistics were recorded for the patients＇ age, GnRH treatment duration （days） and dose, timing and duration of GnRH antagonist treatment, serum E2 and LH level on the day of antagonist use and hCG injection, number ofoocytes retrieved, and clinical pregnancy rate. Results The clinical pregnancy rate was 46.2% per ET cycle for GnRH antagonist group and 56.8% in GnRH agonist group, showing no significant difference between the two protocols. The age of the patients with GnRH antagonist averaged 35.7±3.8 years. Gn and GnRH antagonist treatment lasted for 8.5±1.6 and 4.5±1.1 days, respectively. On the day of ovulation triggered by hCG, the serum estradiol level was 1616.7±721.1 pg/ml, and a mean of 7.4±4.6 oocytes was collected per retrieval. The number of the embryos transferred was 2.4±0.6, with an implantation rate of 27.7%, resulting in a clinical pregnancy rate of 50.0% in the fixed protocol （antagonist initiation on day 4 or 5 of stimulation） and 37.5% in the flexible protocol （antagonist treatment initiated for a follicle of 12-15 mm, on day 6 to 9 of stimulation）. Conclusions GnRH antagonists treatment results in good outcomes and can be safe, short, convenient and effective for Chinese women undergoing COH for IVF. GnRH antagonist treatment can be initiated on day 4 to 9 of Gn stimulation to obtain comparable pregnancy rate.