促性腺激素用药前垂体降调节时间对妊娠结局的影响

Influence of days of downregulation on pregnancy outcomes before gonadotrophin therapy

目的:探讨促性腺激素(Gn)用药前最佳降调节时间。方法:将2006年3月至2007年8月在本中心接受体外受精-胚胎移植或卵泡浆内单精子显微注射的不孕患者216例,按照Gn用药前垂体降调节时间的不同分为3组,A组≤10d,B组11～14d,C组≥15d。回顾性分析比较不同垂体降调节时间对获卵数、优质胚胎率、临床妊娠率的影响。结果:3组患者年龄、基础内分泌水平[雌二醇(E2)、卵泡刺激素(FSH)、黄体生成素(LH)、孕激素(P)]、人绒毛膜促性腺激素注射日E2、LH、P水平及内膜厚度没有明显差异(P>0.05);C组Gn用药时间、剂量明显高于A、B组(P<0.05);3组获卵数没有明显差异(P>0.05);优质胚胎率、临床妊娠率A组与C组之间没有明显差异(P>0.05),但B组与A、C组之间差异明显(P<0.05)。结论:Gn用药前垂体降调节时间对妊娠结局有一定的影响,降调节时间≥15d时需增大Gn用量及时间,降调节时间11～14d时可得到较高的优质胚胎率和临床妊娠率。

Objective To investigate the optimal days of downregulation before gonadotrophin （Gn） therapy. Methods 216 infertile females who received IVF or ICSI in our center from March 2006 through August 2007 were divided into group A （≤10d）, group B （11 - 14 d）, and group C （≥15d） according to days of downregulation before the use of Gn. The effects of days of downregualtion on the number of retrieved oocytes, rate of high quality embryos, and clinical pregnancy rate were retrospectively analyzed. Results There were no significances among the three groups in age, baseline levels of E2, FSH, LH, and P, levels of E2, LH, and P and thickness of the endometrium on the day of hCG injection （P 〉 0.05）. The days and dosage of Gn therapy were greater in group C than in groups A and B （P 〈 0.05）. The number of retrieved oocytes did not differ significantly among the three groups （P 〉 0.05）. The rate of high quality embryos and clinical pregnancy rate differed significantly between group B and group A or C （P 〈 0.05） but not between group A and group C （P 〉 0.05）. Conclusions Days of downregulaion has an effect on the pregnancy outcomes before Gn therapy. If days of downregulaion were beyond 15, the dosage and duration of Gn therapy should be increased. A greater rate of high quality embryos and a higher clinical pregnancy rate can be obtained when days of downregulation are between 11 and 14.