不同剂量GnRH-a超长降调节在EMs患者中的应用研究

Effect of Modified Prolonged Gonadotropin-releasing Hormone Agonist Therapy on the Outcome of the in vitro Fertilization-embryo Transfer in Patients with Endometriosis

目的探讨不同剂量促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRH-a)超长降调节对改善子宫内膜异位症(endometriosis,EMs)患者体外受精/胚胎移植(IVF-ET)结局的作用。方法将50例子宫内膜异位症患者(腹腔镜术后)随机分为两组接受改良超长方案治疗,A组(末次半量组):30例患者GnRH-a治疗3～6个月,每次1.88mg(1/2支)达菲林肌内注射,间隔28天,第2次注射达菲林后2周开始检测血清CA125,CA125降至18U/L以下后注射末次达菲林1/2支;B组(末次0.375mg组):20例患者末次治疗剂量改为0.375mg(1/10支)达菲林肌内注射。两组均于末次达菲林注射后2～6周开始尿促性腺激素(human menopausal gonadotropin,HMG)225～300U(3～4支)肌内注射促进卵泡发育,于最大卵泡直径≥16mm时注射绒毛膜促性腺激素(human chronic gonadotropin,HCG)5000～10000U,32～36h后取卵,取卵后48～72h胚胎移植。结果启动日黄体生成素(luteinizing hormone,LH)水平A组低于B组,差异有统计学意义(P=0.04)。A组HCG日孕酮(pro-gesterone,P)水平低于B组,差异有统计学意义(P=0.05),B组有2例HCG日P升高至3.0ng/ml以上。A组受精率0.77±0.03,高于B组,差异有统计学意义(P=0.02)。平均用药天数,总剂量,两组比较差异无统计学意义(P>0.05)。平均获卵数,优质胚胎率,种植率,妊娠率,两组比较差异无统计学意义(P>0.05)。A组妊娠率69%,B组妊娠率50%,均高于本中心同期子宫内膜异位症患者行超长后短方案组妊娠率(40.05%)。结论两种剂量GnRH-a超长降调节治疗在子宫内膜异位症患者中应用均改善了其IVF结局,0.375mg GnRH-a可能不能全程抑制自发LH峰,可能仍需联合短方案才能达到预期目的,但由于抑制程度轻,对卵巢功能低下的妇女可能获得较好的结局。

To investigate the outcome of in vitro fertilization and embryo transfer （IVF - ET） in patients with endometri- osis following modified prolonged gonadotropin -releasing hormone agonist （GnRH -a） therapy combined with human menopausal gona- dotropin （HMG） stimulation. Methods Thirty patients received three to six courses of long - acting GnRH agonist, 1.88mg i.m. every 28 days. Twenty patients also did, but the last GnRH agonist dose was 0,375mg. HMG started 14 - 42days later. Conventional IVF - ET was performed as routine procedure. The clinical outcomes were compared between these two groups. Results There was no significant difference in total gonadotropin （Gn） using days and doses between the two groups. The progesterone （P） level on hCG day was I. 07 ＋ 0. 13ug/ml in group A, and it was significantly lower than that in group B. The fertilization rate was 0.77 ± 0.03 in group A, also signifi- cantly higher than that in group B. There were no significant difference in the high - quality - embryo rate, implantation rate or clinical pregnancy rate between the two groups. Conclusion The outcome of in vitro fertilization and embryo transfer （ IVF - ET） in patients with endometriosis was improved if following modified prolonged GnRH - a therapy. Maybe the dose of 0. 375mg GnRH - a can＇t control the spontaneous LH peak during the full ovary hyperstimulation, but it＇s beneficial to those women with poor ovarian function.