口服避孕药在IVF-ET短方案促排卵中的作用

The role of oral contraceptives in the GnRH-a flare-up protocol in IVF-ET

目的观察口服避孕药(OCP)在体外受精-胚胎移植(IVF-ET)短方案促排卵中的作用。方法对因输卵管因素或男方因素行IVF-ET的不孕患者共112例,均采用短方案促排卵,其中实验组59例,于促排卵前给予OCP口服1个月;对照组53例,促排卵前不给予OCP预处理,常规月经第3天促排卵。比较两组患者自然月经周期D3天和COH周期月经D3天的基础卵泡及内分泌情况;比较两组Gn使用天数、Cn总量、HCG日LH、E2、P水平;比较两组取卵日成熟卵泡情况、获卵数、受精率、卵裂率、可用胚胎数、优质胚胎数、周期取消率、临床妊娠率的差异。结果①两组患者的年龄、不孕年限、自然月经周期基础FSH、LH、E2比较无显著性差异(均P>0.05);两组患者COH周期月经D3天FSH、LH、E2水平及HCG日LH、E2、P水平比较无显著性差异(均P>0.05);②COH周期月经D3天有>5mm卵泡的患者数,实验组较对照组明显减少(P<0.05),实验组卵泡发育同步性好,卵泡大小相对较均匀;③平均Gn天数及用量实验组较对照组多(P<0.05);④周期取消率实验组较对照组低(P<0.05);⑤取卵日≥15mm成熟卵泡数、获卵数、可移植胚胎数、临床妊娠率实验组较对照组高(P<0.05);⑥两组受精率、卵裂率、优质胚胎数等差异无显著性(均P>0.05)。结论在IVF-ET短方案中,在GnRH-a+Gn促排卵前用OCP预处理,能调整月经周期,使卵泡发育同步性增加,能获得比较好的促排卵效果,取卵日成熟卵泡数及获得的卵子数均较多,周期取消率降低,临床妊娠率能够得到适当的提高。但OCP预处理后可能抑制了早期内源性FSH的上升,对卵巢的抑制加重,使小卵泡发育缓慢而用药时间延长。

Objective：To observe the role of oral contraceptives（OCP） in the GnRH-a flare-up protocol in in-vitro fertilization-embryo transfer（IVF-ET）.Methods：The objects of the study were 112 cases with infertility for tubal factor or male factor and they were dealed with IVF-ET.The protocol of COH was GnRH-a short flare-up protocol.All of the 112 cases were divided into two groupes ：the experimental group with 59 cases who were given oral contraceptives one month before COH;the controlled group with 53 cases who were not given oral contraceptives one month before COH.Compare follicular and endocrine conditions of D3 days in the natural cycle of menstruation and COH cycle between two groups;Compare the levels of LH,E2 and P on the day of HCG administration between two groups;Compare the total dose and the periods of using gonadotrophins between two groups;Compare the numbers of mature follicles and oocytes retrieved on the day of oocyte picking-up;The rates of oocyte fertilization,embryo cleavage,cycle cancellation and clinical pregnancy and the number of available embryos and high quality embryos were also compared between two groups.Results：①There were no statistical differences between the two groups in the patients′ age and their infertility periods,and in the levels of FSH,LH,E2 on the day of D3 days in the natural cycle of menstruation and COH cycle（P 0.05 respectively）;②There were also no statistical differences between the two groups in the levels of LH,P,E2 on the day of HCG administration（P 0.05 respectively）;③The number of patients who had follicles larger than five millimeters in the D3 days of COH cycle was fewer in the experimental group than in the controlled group（P0.05）;Follicular development was more synchronized and the size of follicle was relatively uniformal in the experimental group;④The total dose and the periods of using gonadotrophins was much more many in the experimental group than in the controlled group（P0.05）;⑤The rate of cycle cancellation was lower in the experimental group（P0.05）;⑥The number of follicles larger than 15 millimeters and oocytes retrieved on the day of oocyte picking-up was more many in the experimental group（P0.05 respectively）;Clinical pregnancy rate and the number of available embryos was higher in the experimental group（P0.05 respectively）;⑦There were no statistical differences between the two groups in the rates of oocyte fertilization and embryo cleavage and in the number of high quality embryos（P0.05 respectively）.Conclusion：Oral contraceptives pretreatment before controlled ovarian hyperstimulation in the short flare-up protocol in IVF-ET can adjust the menstrual cycle and synchronize the development of follicles;We can get more mature follicles and oocytes if we pretreat with oral contraceptives;Also we can reduce cycle cancellation rate and improve clinical pregnancy rate.But the period of using gonadotrophins would be longer after OCP pretreatment,supposing that oral contraceptives may inhibit the rise of endogenous FSH levels in early follicular phase and enhance the degree of pituitary down-regulation which may postpone the development of small follicles.