长效曲普瑞林不同剂量在体外受精-胚胎移植中的治疗效果比较

Evaluation of the Down-regulation effects with one-fourth-dose and with a half-dose depot triptorelin in IVF-ET

目的探讨1/4支与1/2支长效曲普瑞林在体外受精-胚胎移植中的治疗效果。方法 290个长方案周期,根据基础窦卵泡数分为A组(<15个)和B组(≥15个),两组内比较1/4支与1/2支长效曲普瑞林的治疗效果。结果促性腺激素(Gn)使用天数,两剂量无差异;Gn用量为1/4支组少于1/2支组,在A组有统计学意义(P<0.05);hCG注射日血清LH水平为1/4支组高于1/2支组,无统计学意义,均无早发LH峰;hCG注射日血清E2为1/4支组显著高于1/2支组(P<0.001),hCG注射日血清P水平为1/4支组高于1/2支组,胚胎种植率为1/4支组低于1/2支组,均在A组有统计学意义(P<0.05);卵巢过度刺激综合症发生率为1/4支组高于1/2支组,在B组有统计学意义(P<0.001);获卵数、正常受精数、优质胚胎数、妊娠率及流产率两剂量均无统计学意义。结论 1/4支和1/2支曲普瑞林均能达到可控制性超促排卵的降调效果;1/4支曲普瑞林在基础窦卵泡较少(<15个)时能减少Gn用量;1/2支曲普瑞林在基础窦卵泡较多时(≥15个)能充分降调节,并能避免血清E2过高,减少卵巢过度刺激的风险,因此降调节时减少GnRHa的用量应当个体化。

Objective：To evaluate the down-regulation effects of one-fourth-dose and a half-dose depot triptorelin in vitro fertilization-embryo transfer（IVF-ET）.Methods：A total of 290 cycles used long protcol was divided into two groups by the number of base antral follicles（AFCs）：group A（AFCs 15） and group B（AFCs≥15）,the down-regulation effects of one-fourth-dose and a half-dose depot triptorelin were compared in group A and group B.Results：The days of ovarian stimulation had no difference;In groups with one-fourth-dose triptorelin,the total dose of gonadotrophin（Gn） used was less with significance in group A（P 0.05）,on the day of hCG given,serum LH level was slightly higher without significance（P 0.05） and without spontaneous premature LH surge,serum E2 level was significantly higher（P 0.001）,serum P level was higher and embryo plantation rate was less with significance in group A（P 0.05）,ovarian hyperstimulation syndrome（OHSS） rate was higher with significance in group B（P 0.001）.The numbers of retrieved and normaly fertilized oocytes and good quality embryos,clinical pregnancy rate and micarrage rate had no difference.Conclusion：The down-regulation effects of one-fourth-dose and a half-dose depot triptorelin may be equal to the convention dose in IVE-ET;using one-fourth-dose depot triptorelin can decrease the total dose of Gn in people with less AFCs（ 15） ;using a half-dose depot triptorelin can suppress pituitary adequately,avoid serum E2 too high and eventually reduce the risk of OHSS in people with more AFCs（≥15）,so down regulation with less dose GnRHa should be individual.