摘要
目的前瞻性随机比较黄体期GnRHa降调节方案中基因重组HCG(r-HCG)与尿源性HCG(u-HCG)在我国妇女中诱导卵子成熟的IVF/ICSI结局及安全性。方法收集接受IVF/ICSI助孕的不孕患者568例,随机分成2组:A组用r-HCG皮下注射诱导排卵,B组用u-HCG肌肉注射诱导排卵,比较两组间诱导卵子成熟效应和临床结局。结果 (1)两组间除2PN率A组明显高于B组外,其余超排卵参数、获卵数、MⅡ卵数、受精率、临床妊娠率等均无统计学差异;(2)两组的早发OHSS率无统计学差异,而晚发OHSS率B组明显高于A组,两组均无患者发生注射后过敏反应等情况;(3)随着血清β-HCG浓度增高BMI逐渐减小,获卵数、MⅡ卵数、MⅡ卵率、受精率、可移植胚胎数均有增加趋势,但着床率和妊娠率并未受到影响;(4)A组中有1例注射r-HCG后血清β-HCG<1.2mU/ml,补注射u-HCG后34-36h取卵获得临床妊娠。结论 r-HCG与u-HCG在黄体期GnRHa降调节方案中能获得基本相同的诱导卵子成熟效应和临床结局;对BMI高的患者可考虑适当加大HCG量以保证足够的HCG浓度;建议HCG注射后12-14h检测血清β-HCG浓度,一旦发现浓度过低,应该更换药物或选择不同批次进行补注射后取卵,尽可能挽救该周期,保证患者利益。
Objective：The aim of the prospective randomized study is to investigate the effect of r-HCG on oocyte maturity compared to u-HCG for introducing ovulation in IVF/ICSI in Chinese women.Methods：We compared 568 patients randomly assigned to one of the two study groups.Group A consisted of 284 women who received a subcutaneous（s.c.） injection of r-HCG and group B consisted of 284 patients receiving an intramuscular（i.m.） injection of u-HCG.Results：There were no statistically differences between the two groups in demographic characteristics（age,BMI,duration of infertility,basal FSH,AFC）.The r-HCG group showed statistically higher 2PN rate than u-HCG group,while the other stimulation parameters,IVF/ICSI outcome and the incidence of OHSS were similar in two groups.There were no side effect of injection were observed in both groups.There was negative correlation of serum β-HCG concentration after 12~14h of r-HCG administration and BMI who with nornal BMI.Increasing with the serum β-HCG concentration 12-14h after HCG administration,the number of oocytes retrieved and mature oocytes,the proportion of mature oocytes,fertilization rate,and the number of embryos increased gradually but there were no significant differences,and the stimulation parameters and IVF outcomes were similar.There was one patient who had lower than 1.2mU/ml serum β-HCG concentration 12h after HCG administration.10000IU u-HCG was supplemented immediately and the patient got clinical pregnancy.Conclusion：Compared with u-hCG,r-HCG appears equally effective in triger final follicular maturation in IVF/ICSI.The study showed,it is recommened to increase rHCG dose for triger ovulation for overweitht patient.Otherwise,routly detect serum β-HCG concentration 12-14h after HCG administration was recommened for if the serum β-HCG very low,supplement of HCG can rescue the final result.
出处
《中国优生与遗传杂志》
2011年第8期96-99,共4页
Chinese Journal of Birth Health & Heredity
