超低剂量长效达菲林降调节对体外受精-胚胎移植结局的影响

Effects of pituitary down-regulation with extremely low dose of GnRH-a on IVF outcomes

目的:探讨超低剂量长效促性腺激素释放激素激动剂(GnRH-a,达菲林)降调节对黄体期长方案体外受精-胚胎移植(IVF-ET)结局的影响。方法:回顾性分析2010年1月至2011年10月在温州医学院附属第一医院生殖医学中心行长方案治疗的1 287例年龄≤38岁患者,共1 287个治疗周期。所有患者在黄体中期注射GnRH-a≤0.6 mg,降调2周后开始促排卵。结果:1 287个周期患者,达菲林剂量≤0.6 mg(平均0.53 mg,约1/7全量),使用GnRH-a后2周,黄体生成素(LH)为(2.16±0.95)IU/L,雌二醇(E2)为(83.03±37.98)pmol/L。促排所需促性腺激素(Gn)总量为(1 710.03±463.42)IU,Gn天数为(10.70±1.73)d。绒毛膜促性腺激素(hCG)注射日LH为(2.75±2.26)IU/L,孕酮(P)为(3.57±2.89)nmol/L,E2为(9 833.21±5 685.94)pmol/L。平均获卵数为(12.24±5.85)个,优胚率为62.85%。154个周期因各种原因未移植,1 133个移植周期中,血hCG阳性率为60.90%,临床妊娠率为54.64%。结论:对于年龄≤38岁,卵巢功能尚正常的患者在黄体期长方案IVF-ET周期中,使用1/7剂量长效GnRH-a降调节能有效地使垂体达到去敏状态,减少Gn用量,而且获得了比较理想的实验室和临床结局。

Objective： To investigate the effects of pituitary down-regulation with extremely low dosegonadotrophin releasing hormone agonist （GnRH-a, Triptorelin） on the outcome of in vitro fertilization-embryo transfer （IVF-ET） cycles. Methods： A total of 1 287 IVF-ET cycles with mid-luteal long protocol from January 2010 to October 2011 in Reproductive Medicine Center, the First Affiliated Hospital of Wenzhou Medical College were retrospectively analyzed. All the infertile women were 〈 38 years old and the dose of GnRH-a injected in mid-luteal phase was ≤ 0.6 mg （an average of 0.53 rag, 1/7 of full dose）, starting induction of ovulation after administration of GnRH-a two weeks. Results： In 1 287 cycles, two weeks after GnRH-a injection, the serum luteinizing hormone （LH） was （2.16 ± 0.95） IU/L, estradiol （E2） was （83.03 ± 37.98） pmol/L. The total dose of gonadotropins （Gn） in controlled ovarian stimulation was （1 710.03 ± 463.42） IU, the days of stimulation was （10.70 ± 1.73）. On the day of human chorionic gonadotropin （hCG） given, serum LH level was （2.75 ± 2.26） IU/L, progesterone （P） was （3.57 ± 2.89） nmol/L, E2 was （9 833.21 ± 5 685.94） pmol/L. The number of retrieved ovaries was （12.24 ± 5.85）, the rate of good quality embryos was 62.85%. 154 cycles were not transplanted for various reasons, in 1 133 transplanted cycles, blood hCG positive rate was 60.90%, clinical pregnancy rate was 54.64%. Conclusion： For the patients less than 38 years old with still normal ovarian function, it was effective to make pituitary suppression by administration extremely low dose GnRH-a in mid-luteal phase of IVF-ET cycles, reduce total dose of Gn and acquire satisfactory laboratory and clinical outcomes.