拮抗剂在不孕症患者微刺激周期中的应用与效果

Application of Antagonists in the Micro-Stimulation Cycle for the Treatment of Patients with Elderly or Poor Ovarian Reserve

目的探讨促性腺激素释放激素拮抗剂(GnRH拮抗剂)配伍HMG方案对不孕症患者微刺激周期的效果。方法对收治的84例不孕患者,根据随机原则分为两组,其中拮抗剂组使用GnRH拮抗剂+HMG方案,共112个周期,非拮抗剂组仅采用HMG方案,共145个周期。对两组患者的年龄、不孕年限、基础黄体生成素(FSH)、基础窦卵泡数(AFC)、Gn用量及天数,HCG日血清中雌二醇(E2)水平、获卵数、受精率、临床妊娠率和胚胎种植率等指标进行比较。结果拮抗剂组的HCG日E2、Gn使用天数和剂量均显著高于非拮抗剂组,黄体生成素(LH)、孕酮(P)的水平显著低于非拮抗剂组,差异具有统计学意义(P<0.05);拮抗剂组的卵子成熟率、卵裂率、优质胚胎率和种植胚胎率分别为90.5%、96.8%、73.2%、11.7%,显著高于非拮抗剂组(85.2%、91.3%、63.6%、5.7%),差异具有统计学意义(P<0.05)。结论 GnRH拮抗剂联用HMG治疗方案对于卵巢低反应患者可有效促排卵,效果较好,值得临床推广。

Objective To explore the micro-stimulation cycle effects of gonadotropin-releasing hormone antagonist （ GnRH an-tagonist） combined HMG program for the treatment of infertility. Methods 84 cases of infertile patients received in our hospital were divided into two groups according to the random principle, the antagonist group were treated by GnRH antagonist ＋ HMG program with a total of 112 cycles ,and the non-antagonist group were only treated by HMG program with a total of 145 cycles. Age, duration of infertility, basic luteinizing hormone （ FSH ） , based antral follicle count （ AFC ） , Gn dosage and the number of years, serum E2 levels in HCG day, number of oocytes, fertilization rate, clinical pregnancy rate, implantation rate and other met-rics in the two groups were recorded and compared. Results E2 levels in HCG day, number of days and dose of Gn in antagonist group were significantly higher than those of non-antagonist group, and LH, progesterone（P） levels were significantly lower than those of non-antagonist group, the difference was statistically significant（ P 〈 0.05 ） ; the egg maturation rate, cleavage rate, embryo quality embryo rate and planting rate in antagonist group were 90.5% ,96.8% ,73.2% and 11.7% respectively,which were sig-nificantly higher than those of the non-antagonist group（85.2% ,91.3% ,63.6% and 5.7% respectively） , the differences were statistically significant（P 〈 0.05 ）. Conclusion GnRH antagonists combined with HMG programs for the treatment for patients with poor response to ovarian had significant ovulation induction effect, it was worthy of clinical promotion.