0.94mg注射用醋酸曲普瑞林长方案降调节在IVF-ET中的临床应用

目的探讨0.94mg注射用醋酸曲普瑞林(达菲林)在体外受精-胚胎移植(IVF-ET)长方案超促排卵中的垂体降调节效果及临床结局。方法选择100例接受IVF-ET的不孕患者,于前一月经周期口服避孕药进行预处理,然后在黄体中期0.94mg达菲林长方案降调节,致垂体完全降调节后加用促性腺激素(Gn),当患者有3个以上卵泡直径≥18mm时,肌注绒促性素(HCG),36h后取卵行IVF,48h后行胚胎移植(ET)。结果 100例取卵周期均达到降调节标准,且HCG日无一例出现隐匿性促黄体生成素(LH)峰。Gn天数(11.89±2.20),获卵数(10.67±5.75),受精数(8.63±4.92),受精率80.88%,卵裂数(8.33±4.92),卵裂率96.18%,可移植胚胎数(6.10±3.79),优胚数(4.40±3.18),优胚率72.13%,92例移植周期中(100例患者中因6例OHSS,2例无可移植胚胎而取消移植)临床妊娠率45.65%,单胎率59.52%,双胎率26.19%,流产率7.13%,异位妊娠率7.14%,生化妊娠率6.52%,OHSS率6%,出生率39.13%。结论 0.94mg达菲林可以达到控制性超促排卵的垂体降调节和抑制LH峰早出现的作用。

Objective To investigate the down-regulation effect and the clinical outcome of 0.94 mg Diphereline which is used in long protocol and controlled ovarian stimulation in IVF-ET. Methods 100 cases of infertility patients undergoing IVF-ET, used the oral contraceptivs before the last menstrual cycle, then 0.94 mg Dipereline in long protocol and down regulation in the midluteal. Due to down-regulation criterion, we used the gonadotrophin, when a patient had more than 3 follicular diameter ≥18 mm, HCG hormone was used to trigger.The egg cell was removed after 36 hours and IVF was done, embryo transfer was done after 48 h. Results 100 cases of oocyte retrieval cycle had reached the down-regulation criterion and the day of HCG, no case of occult luteinizing hormune（LH）peak, the days of Gn （11.89±2.20）,number of oocytes retriveved （10.67±5.75）, fertilized oocytes （8.63±4.92）, fertilization rate 80.88%, the cleavage number （8.33±4.92）, the cleavage rate 96.18%, the number of transferable embryos （6.10±3.79）, high quality embryo（4.40±3.18）, the rate of high quality embryo 72.13 %, 92 cases of transfer cycles（100 patients for 6 cases of OHSS,2 cases without embryos and cancel translation） pregnancy rate 45.65%, single rate 59.52% ,twin pregnancy rate 26.19%, abortion rate 7.13 %, ectopic pregnancy rate 7.14%, the rate of biochemical pregnancy rate 6.52%, OHSS 6%, delivery rate 39.13 %. Conclusion 0.94 mg Dipereline had the effect of down-regulation and inhibition of LH peak.