改良长方案的控制性超促排卵方案在体外受精-胚胎移植中的应用

Clinical applicattion of a modified long down-regulation protocol in controlled ovarian hyperstimulation during in vitro fertlization and embryo transfer

目的探讨延长促性腺激素释放激素激动剂(GnRH-a)使用时间的控制性超促排卵(COH)方案对体外受精-胚胎移植(IVF-ET)助孕临床结局的影响。方法回顾性分析改良长方案336个周期和常规长方案358个周期,比较两种COH方案的促排卵药使用情况、激素变化及助孕结局。结果两组患者的年龄、不育年限、体重指数(BMI)无统计学差异(P>0.05)。改良长方案组促性腺激素(Gn)使用天数与常规长方案无显著差异(P>0.05),但Gn使用剂量较常规长方案组多,药费却显著低(P<0.001)。改良长方案组基础和启动日的卵泡刺激素(FSH)和雌二醇(E_2)高于常规长方案组(P<0.01),启动日和人绒毛膜促性腺激素(HCG)日的黄体生成素(LH)则显著低于常规长方案组(P<0.01),两组HCG日E_2无统计学差异(P>0.05)。改良长方案组启动日窦卵泡数、获卵数、受精数、胚胎数均少于常规长方案,但临床妊娠率、胚胎种植率及活产率高于常规长方案组(P<0.05),两组间优质胚胎数、移植胚胎数、早期流产率无统计学差异(P>0.05)。结论延长GnRH-a使用时间方案(改良长方案)较常规长方案更有利于提高IVF-ET临床妊娠率、胚胎种植率及活产率,并减少促排卵药物的费用。

Objective： To explore the effect of prolonged duration of gonadotrophin releasing （GnRH-a） in controlled ovarian hyperstimulation （COH）on the outcomes of in vitro embryo transfer（IVF-ET）. hormone agonist fertilization and Methods： The two COH protocols including prolonged duration of GnRH-a protocol（modified long protocol） and routine long protocol were studied retrospectively. The characteristics of ovulation induction and IVF-ET outcomes were compared between the two protocols. Results： There were no statistically significant differences in female age, infertility duration and body mass index（BMI）in the two groups（P〉0. 05）. No significant difference was found in the duration of stimulation（P〉0.05）. Total dose of gonadotropins（Gn）was significantly higher in modified long protocol than routine long protocol, however, the cost of gonadotropin was significantly less （P〈0. 001）. Basal follicle stimulating hormone（FSH）concentration, FSH and estradiol（E2 ）on Gn starting day were higher in modified long protocol（P〈0. 001）. The levels of luteinizing hormone（LH）on Gn starting day and HCG day were lower in modified long protocol（P〈0. 001）. No statistically significant difference was found in E2 levels on HCG day（P〉0.05）. The antral follicle count（AFC）on Gn starting day,the number of oocytes, fertilized oocytes and embryos were significantly less those in modified long protocol（P〈0.05）. However, significantly higher implantation rate, clinical pregnancy rate and live birth rate were observed in modified long protocol（P〈0.05）. There was no significant difference in the number of high-quality embryos embryos transferred and early miscarriage rate between the two groups（P〉0.05）. Conclusions： The prolong duration protocol of GnRH-a （modified long protocol）can improve implantation rate, clinical pregnancy rate and live birth rate,and reduce the cost of gonadotropins.