口服避孕药用量对超促排卵的影响

Effect of oral contraceptive pills dose on controlled ovarian hyperstimulation

目的:探讨超促排卵长方案中,采用口服避孕药联合促性腺激素释放激素激动剂双降调在体外受精-胚胎移植中的应用价值。方法:共收集397例月经规律患者行体外受精-胚胎移植,均采用长方案超促排卵,降调节均为达菲林0.1 mg隔日皮下注射共7支;其中未服用妈富隆组25例(Ⅰ组),于月经第19天直接降调;常规服用妈富隆组194例(Ⅱ组),于月经第3天起服用妈富隆,1次/日,共21片,于月经第19天降调;加用剂量组(Ⅲ组)178例于月经第3天起服用妈富隆,1次/日,服用22～63片,其中服用2个周期(42片)及3个周期(63片)有9例,于月经第19～21天降调。结果:降调后E2、LH水平用药组较未用药组低,LH水平加大剂量组较常规用药组激素水平更低;而优势卵泡数未用药组较加大剂量组高;降调天数、获卵数、GN用量、HCG日内膜厚度、可用胚胎数、妊娠率、受精率、OHSS发生率无统计学差异。结论:①在体外受精-胚胎移植长方案中,对于月经规律患者应用口服避孕药可以更有效抑制激素水平,达到充分降调节,不影响内膜厚度、获卵数、妊娠率等,建议应用口服避孕药;②口服避孕药用量越大,降调后激素水平越低,优势卵泡数减少,建议应用1个周期的口服避孕药,不推荐口服避孕药长时间应用。

Objective：To explore the application value of oral contraceptive pills（OCPs） combined with gonadotrophin releasing hormone agonist（GnRH-a） in dual suppression of in vitro fertilization-embryo transplantation（IVF-ET） in long protocol of controlled ovarian hyperstimulation.Methods：397 cases with regular menstruation received IVF-ET（long protocol of controlled ovarian hyperstimulation）,0.1 mg Diphereline was injected subcutaneously every two days for 7 times;25 cases did not take Marvelon（group Ⅰ）,down-regulation was performed on the nineteenth day of menstruation;194 cases took Marvelon conventionally（group Ⅱ） from the third day of menstruation,once a day for 21 pills,then down-regulation was performed on the nineteenth day of menstruation;178 cases took large dose Marvelon（group Ⅲ） from the third day of menstruation,once a day for 22～63 pills,9 cases took large dose Marvelon for two cycles（42 pills） and three cycles（63 pills）,down-regulation was performed on the 19th～21st day.Results：After down-regulation,the levels of E2 and LH in medication group were significantly lower than those in non-medication group,the levels of hormones in group Ⅲ were significantly lower than those in group Ⅱ;the number of dominant follicles in group Ⅰ was larger than that in group Ⅲ;there was no significant difference in days of down-regulation,the number of retrieved oocytes,the dose of GnRH-a,the endometrial thickness on HCG day,the number of available embryos,the pregnancy rate,the fertilization rate and the incidence of OHSS among the three groups.Conclusion：In long protocol of IVF-ET,oral contraceptive pills can be used for cases with regular menstruation in order to suppress the levels of hormones effectively and achieve sufficient down-regulation,which do not affect the endometrial thickness,the number of retrieved oocytes and the pregnancy rate;after down-regulation,the level of hormones and the number of dominant follicles decreases with the increase of oral contraceptive pills dose,taking oral contraceptive pills for one weeks is advised,it is not recommended to take oral contraceptive pills chronically.