两种国产短效曲普瑞林减量长方案在IVF/ICSI中应用的临床效果比较

Comparison between two types of short-acting triptorelin tapering GnRH-a long protocol in IVF-ET

目的:分析2种国产短效曲普瑞林减量长方案在IVF/ICSI中应用的临床效果,探寻减量长方案中更为方便有效的曲普瑞林减量方法。方法:回顾性分析采用长方案降调节行IVF/ICSI治疗的284个周期,根据启动日短效曲普瑞林不同减量方法分为A、B两组。A组于启动日开始曲普瑞林改为0.05mg/日直至HCG日;B组启动日开始曲普瑞林改为0.1mg/隔日直至HCG日。比较两组患者曲普瑞林用量,Gn总量、Gn天数、平均获卵数、移植胚胎数、优质胚胎率、胚胎种植率、临床妊娠率、早期流产率、中重度OHSS发生率。结果:两组患者曲普瑞林用量和天数,Gn总量、Gn天数、平均获卵数、移植胚胎数、优质胚胎数、胚胎种植率、临床妊娠率、早期流产率及OHSS发生率之间无统计学差异(P>0.05);两组均没有出现早发LH峰及提前排卵,两组间HCG日LH、E2及P值比较均无统计学差异。结论:在短效曲普瑞林降调节长方案超排中,曲普瑞林半量每日注射和原量隔日注射均能达到相同的效果,但曲普瑞林原量隔日注射的临床妊娠率有增高趋势,而且由于减少了注射次数,可以提高患者的依从性。

Objectives： To analyse clinical effects of the two types of domestic short acting Triptorelin tapering GnRH a long protocol in IVF/ICSI, so as to identify a more convenient and efficient tapering protocol of triptorelin in GnRH a long pro tocol. Method： We retrospectively analysed 284 IVF/ICSI cycles where GnRH a long protocol was adopted. The enrolled cases were divided into Group A and Group B according to the triptorelin tapering protocols on the day of initiation. Triptorelin adminis tration in Group A was switched to 0.05mg intramuscular injection daily until the day of HCG injection, while Group B received triptorelin 0.1 mg intramuscular injection every other day until HCG trigger. Gn dosage, stimulating days, number of retrieved oo cytes, number of transplanted embryos, rates of quality embryos, implantation rates, clinical pregnancy rates, miscarriage rates in early pregnancy, incidences of moderate or severe ovarian hyperstimulation syndrome （OHSS） between the two groups were compared. Results： Differences of Gn dosage, stimulating days, number of retrieved oocytes, number of transplanted embryos, rates of quality embryos, implantation rates, clinical pregnancy rates, miscarriage rates in early pregnancy, incidences of moder ate or severe ovarian hyperstimulation syndrome （OHSS） were not statistically significant between the two groups （P 〉 0.05 ）. No premature ovulation due to premature LH surge was identified in either group. There was no statistically significant difference in luteinizing hormone （ LH）, estradiol （E2） or progesterone （P） on the day of HCG injection between the two groups （ P 〉 0.05 ）. Conclusion： Similar effects were achieved with halved daily triptorelin administration and injections of the original dosage on ev ery other day＇ s basis. Since fewer injections are required, the every other day triptorelin tapering protocol may be able to foster patients＇ compliance and hence promote its clinical applications.