不同药物长方案垂体降调对IVF-ET临床结局影响

THE EFFECTS OF DIFFERENT LONG PROTOCOLS OF PITUITARY DOWN-REGULATION ON THE OUTCOMES OF IVF-ET

目的比较不同药物长方案垂体降调对体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析长方案控制性超促排卵211例病人的临床资料。211例病人根据使用曲普瑞林的剂型及剂量分为A组和B组,A组147例采用长效曲普瑞林1.20mg降调节,B组64例采用短效曲普瑞林0.05mg/d降调节。比较两组降调情况、促性腺激素(Gn)用量、Gn应用时间及药物费用,获卵数、优胚数、临床妊娠率、种植率、流产率及持续妊娠率等。结果两组相比较,Gn应用日血清雌二醇(E2)、黄体生成激素(LH)差异无统计学意义(P>0.05),卵泡刺激素(FSH)差异有显著性(t=-2.909,P<0.05),但均已达降调标准。A组Gn应用时间及剂量明显高于B组(t=4.555、4.582,P<0.05),B组总药物费用高于A组(t=-3.057,P<0.05)。获卵数、优胚数、临床妊娠率、种植率、流产率、持续妊娠率两组比较差异无显著性(P>0.05)。结论长效与短效曲普瑞林均能达到控制性超排卵的垂体降调节作用,短效曲普瑞林周期药物费用高于长效曲普瑞林;长效与短效曲普瑞林降调节方案的IVF临床结局无明显差异。

Objective To compare the effects of different long protocols of pituitary down regulation on the outcomes of in vitro fertilization-embryo transfer （IVF-ET）. Methods A retrospective analysis was done in clinical data of 211 patients trea- ted with long protocol of pituitary down-regulation for controlled ovarian hyperstimulation （COH）. The patients were divided into groups A and B according to preparation form and dosage of Triptorelin used. In group A, 147 patients received 1.2 mg prolonged- action Triptorelin intramuscularly, 64 patients in group 13 received 0.05 mg/d short-acting Triptorelin subcutaneously. Pituitary down-regulation, dose, duration and cost of gonadotropin （Gn） used, the number of ova and excellent embryo obtained, clinical pregnancy rate, implantation rate, abortion rate, and continuing pregnancy rate were compared between the two groups. Results On the day of Gn medication, the differences of the levels of serum estradiol （E2） and luteinizing hormone （LH） between the two groups were not significant （P〉0.05）, and the difference of follicle stimulating hormone （FSH） was significant （t= --2. 909, P〈0.05）, but all reached the standard of down regulation. The duration of Gn application was longer and the dosage used was higher in group A than group B （t=4. 555,4. 582;P〈0.05）, the total cost of Gn in group B was higher than group A. The differences between the two groups were not significant in terms of the number of ova and excellent embryo obtained, clinical pregnancy rate, implantation rate, abortion rate, and continuing pregnancy rate （P〉0.05）. Conclusion Both long- and short-acting Triptorelin can reach pituitary down-regulation of COH, but the medical cost of short-acting Triptorelin group is higher. The clinical outcomes of IVF-ET are similar between groups A and B.