促性腺激素释放激素激动剂长方案与拮抗剂方案对体外受精治疗妊娠结局的影响

Comparison of gonadotropin releasing hormone agonist long protocol and gonadotropin releasing hormone antagonist protocol in infertile women

目的:探讨采用促性腺激素释放激素激动剂(gonadotropin releasing hormone agonist,GnRH-a)长方案和促性腺激素释放激素拮抗剂(gonadotropin releasing hormone antagonist,GnRH-ant)方案促排卵对体外受精患者治疗的效果和对妊娠结局的影响。方法:对北京大学第三医院生殖医学中心2010年6月1日至2012年6月1日体外受精-胚胎移植的2 444个周期进行回顾性分析。根据促排卵方案不同将其分为:GnRH-a组(激动剂组,1 706周期)和GnRH-ant方案组(拮抗剂组,738周期),对患者的一般资料、治疗和妊娠结局进行比较。结果:患者的体重指数、年龄、不孕年限、窦卵泡数等一般情况组间比较差异均无统计学意义,人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射日血E2激动剂组更高[(10 595±7 368)pmol/L vs.(9 087±7 035)pmol/L],Gn用药天数激动剂组更长[(12.5±1.8)d vs.(9.4±1.7)d],Gn用量更大[(3 107±1 377)IU vs.(2 084±903)IU],获卵总数激动剂组更多[(13.4±6.6)vs.(11.8±6.4)],差异均具有统计学意义(P<0.05);两组患者移植胚胎数、卵裂率、受精率相互比较,组间差异无统计学意义,可利用胚胎数激动剂组多于拮抗剂组[(5.6±4.5)vs.(5.1±4.3)],差异具有统计学意义(P<0.05)。两种促排卵方案的流产率、胚胎停育率、异位妊娠率和早产率、过期产率和活胎畸形率比较差异无统计学意义,但激动剂组临床妊娠率较高(44.0%vs.38.3%),足月分娩率亦较高(64.2%vs.56.9%),差异均具有统计学意义(P<0.05)。结论:GnRH激动剂长方案促排卵治疗临床妊娠结局和分娩结局均优于拮抗剂方案。

To compare the clinical outcomes of GnRH agonist （GnRH-a） long protocol and GnRH antagonist （GnRH-ant）protocol in vitro fertilization （IVF）-embryo transfer （ET） cycles, and to explore the optimized protocol for infertile women. Methods： From June 2010 to June 2012, 2 444 infertile women underwent their IVF cycles in Peking University Third Hospital, which were divided into 1 706 GnRH agonist long protocol and 738 GnRH antagnist protocol groups. The data of the general demographic、treatment and clinical outcome were compared between the two groups. Results： The age, body mass index（BMI）, infertile duration, antral follicle count （AFC） did not reach statistical difference, the level of estradiol on the day of HCG： injection was higher in GnRH agonist group [（10 595±7 368）pmol/L vs. （9 087±7 035） pmol/L], and the mean length of stimulation was longer in GnRH agonist group[（12.5±1.8） d vs.（9.4±1.7） d], The dose of Gn [（3 107±1 377） IU vs. （2 084±903）IU]was higher in GnRH agonist group. The number of ovum was 13.4±6.6 in GnRH agonist group and 11.8±6.4 in GnRH antagonist group. Those clinical parameters all reached statistical difference （P〈0.05）. The number of the transfer embryos, fertilization rate, and cleavage rate did not reach statistical difference, but the number of the embryos was 5.6±4.5 in GnRH agonist group and 5.1±4.3 in GnRH antagonist group,reached statistical difference （P〈0.05）. The abortion rate, embryonic death rate, ectopic pregnancy rate, preterm labor rate, postterm pregnancy rate, fatal malformations rate showed no statistical difference, but the GnRH agonist long protocol had higher pregnancy rate （44.0% vs. 38.3%）, and higher term pregnancy rate （64.2% vs. 56.9%） compared with GnRH antagonist protocol, thus those parameter reached significant difference （P〈0.05）. Conclusion： Compared with GnRH-antagnist protocol, GnRH agonist long protocol had higher pregnancy rate and better pregnancy outcome.