GnRH-a对内异症不孕患者术后妊娠情况的影响

Effect of gonadotropin-releasing hormone analogue on pregnancy outcomes of infertile patients after operation

目的:探讨促性腺激素释放激素激动剂(GnRH-a)短期治疗对内异症合并不孕患者术后妊娠情况的影响。方法:回顾性分析2003年9月～2007年9月在中山大学孙逸仙纪念医院行手术治疗的110例内异症不孕患者的临床资料,67例患者(观察组)术后予GnRH-a注射治疗3个疗程,其余43例患者(对照组)术后即鼓励其生育,观察两组患者受孕情况。结果:观察组患者总妊娠率较对照组高,但差异无统计学意义(P>0.05)。两组患者治疗后12个月内妊娠妇女占82.2%。轻度患者术后使用GnRH-a较未使用者妊娠率并无明显提高。两组妊娠妇女之间流产率比较无统计学差异(P>0.05)。结论:此研究未发现术后联合GnRH-a治疗子宫内膜异位症合并不孕患者3个月能显著提高其妊娠率。Ⅰ、Ⅱ期患者盆腔病变轻微,术后宜尽快受孕,可暂不使用GnRH-a治疗。经手术或联合GnRH-a治疗后患者首次妊娠多发生在治疗后1年内,如果1年以上仍未妊娠,应尽早鼓励患者行辅助生育技术,以增加受孕机会。

Objective：To explore the effect of short-term treatment of gonadotropin-releasing hormone analogue（GnRH-a） on pregnancy outcomes of infertile patients with endometriosis after operation. Methods：The clinical data of 110 infertile patients with endometriosis who received surgical therapy in the hospital from September 2003 to September 2007 were analyzed retrospectively,67 patients in observation group were treated with intravenous injection of GnRH-a for three courses after operation;the other 43 patients in control group were encouraged to get pregnancy,the conception conditions in the two groups were observed. Results：The total pregnancy rate in observation group was higher than that in control group,but there was no significant difference（P0.05）;at 12 months after treatment,the pregnancy rate in the two groups was 82.2%;among mild patients,there was no significant difference in pregnancy rate between the patients receiving GnRH-a and the patients not receiving GnRH-a;there was no significant difference in abortion rate between the two groups（P0.05）. Conclusion：It is not found that intravenous injection of GnRH-a for three months after operation can improve the pregnancy rate of infertile patients with endometriosis;the pelvic lesions of patients of stage Ι and Ⅱ are mild,it is recommended to get pregnancy as soon as possible,GnRH-a treatment should be paused;the patients get the first pregnancy mostly in the first year after surgery or combined with GnRH-a therapy,assisted reproductive technology should be early encouraged for those patients remaining infertile for over one year after treatment in order to increase the chance of successful conception.