子宫腺肌病伴不孕症患者采用不同体外受精助孕方案的疗效分析

Effect of Different in Vitro Fertilization Treatment Protocols on Infertile Women with Adenomyosis

目的探讨各种不同体外受精(IVF)助孕方案对子宫腺肌病伴不孕症患者的疗效。方法对2006年1月-2009年6月进行IVF助孕治疗的子宫腺肌病伴不孕症患者63例的临床资料进行回顾性分析。根据是否应用长效促性腺激素释放激素激动剂(GnRH-a)及启动促性腺激素(Gn)时间分为超长方案、长效GnRH-a后长或短方案、常规长方案3组,对IVF助孕疗效进行分析。结果 3种治疗方案的Gn刺激天数、Gn总量、获卵数、不良反应发生率和流产率比较无统计学意义(P>0.05);3种治疗方案的周期取消率为20.0%、7.7%、30.0%,比较有统计学意义(χ2=5.74,P<0.05),方案2的周期取消率低于方案1和方案3,有统计学意义(χ2=7.21,P<0.05);3种治疗方案的继续妊娠率为23.0%、37.0%、15.3%,有统计学意义(χ2=11.31,P<0.05),方案2的继续妊娠率高于方案1和方案3,有统计学意义(χ2=8.52,P<0.05)。结论与超长方案和常规长方案相比,子宫腺肌病伴不孕症患者采用长效GnRH-a治疗后长方案或短方案行IVF助孕治疗,妊娠率升高,周期取消率降低。

Objective To investigate the effect of different in vitro fertilization （ IVF） treatment protocols on infertile women with adenomyosis. Methods Sixty-four infertile women with adenomyosis who had IVF treatment cycles from January 2006 to June 2009 were retrospectively analyzed. According to administration of long course gonadotropin-releasing hormone agonist （ GnRH-a） and the start time of gonadotropin （ Gn） ,all participants were divided into three groups：the first group with ultra-long term protocol,the second group with long or short term protocol after administration of long course GnRH-a and the third group with routine long term protocol. Results There were no differences among the three groups with regard to days of Gn administration,amounts of Gn administration,numbers of retrieved oocytes,prevalence of poor response and miscarriage （ P〉 0. 05）. The cancelation rates of the three groups were 20. 0% 、7. 7% and 30. 0% respectively. There were significant differences in cancelation rates among the groups （ χ2 = 5. 74,P 〈0. 05） ,and the cancelation rate in the second group was significantly lower than the other groups （ χ2 = 7. 21,P 〈0. 05）. The ongoing pregnancy rates of the groups were 23. 0% 、37. 0% and 15. 3% respectively. There were significant differences in ongoing pregnancy rates among three groups （ χ2 =11. 31,P〈 0. 05） ,and the ongoing pregnancy rate in the second group was significantly higher than the other groups （ χ2 =8. 52,P 〈0. 05）. Conclusion Compared with the ultra-long term and routine long term protocol of IVF treatment in infertile woman with adenomyosis,the ongoing pregnancy rate might be higher and the cancelation rate might be lower in the long or short term protocol after administration of long course GnRH-a.