口服避孕药预处理对促性腺激素释放激素激动剂长方案妊娠结局的影响

Effects of oral contraceptive pretreatment on clinical outcome in long GnRH agonist protocol

目的评价口服避孕药(OC)妈富隆预处理对体外受精-胚胎移植(IVF-ET)中促性腺激素释放激素激动剂(GnRH-a)降调节长方案妊娠结局的影响。方法回顾性分析我中心2011年10月至2012年12月IVF患者450例,其中OC组193例服用妈富隆,于月经周期第21天开始GnRH-a降调节治疗,对照组257例自发排卵后一周同法治疗,比较两组促排卵过程及第一次胚胎移植(鲜胚或冻融胚胎)结局。结果 OC组与对照组在降调节时间、促性腺激素(Gn)用药天数、Gn用药量、获卵数、2PN受精率、优胚率、平均移植胚胎数、宫外孕率、流产率、卵巢囊肿及OHSS发生率方面均无统计学差异(P>0.05),OC组HCG日血清LH水平、移植日子宫内膜厚度低于对照组(P<0.05),临床妊娠率、种植率、活产率低于对照组(P<0.05)。冻融胚胎移植周期OC组与对照组在移植日子宫内膜厚度、平均移植胚胎数、临床妊娠率、种植率、宫外孕率、流产率、活产率均无统计学差异(P>0.05)。结论 GnRH-a降调节长方案使用OC预处理可能通过影响子宫内膜厚度降低鲜胚移植周期临床妊娠率及活产率,似乎不影响冻融胚胎移植周期的妊娠结局。

Objective：To evaluate the effect of oral contraception（OC）pretreatment on clinical outcome in long GnRH agonist（GnRH-a）protocol.Methods：The clinical data of 450 patients undergone IVF in our centre from October 2011 to December 2012 were analyzed retrospectively.Among them,193 patients were treated with Marvelon,which was started on day 21 in a long GnRH agonist protocol cycle as OC group,and 257 patients received GnRH-a down-regulation after spontaneous ovulation as control group.The clinical outcomes in fresh or frozen-thawed cycles were compared between the two groups.Results：The duration and amount of gonadotropin（Gn）used,number of retrieved oocytes,2PN rate,high-quality embryo rate,mean number of embryo transferred,ectopic pregnancy rate,miscarriage rate,occurrence of ovarian cysts or ovarian hyperstimulation syndrome（OHSS）had no statistical difference between the two groups（P〉0.05）.The LH levels and endometrial thickness on HCG day in OC group were lower than those in control group（P〈0.05）.The clinical pregnancy rate,implantation rate and live birth rate in OC group were significantly lower than those in the control group（P〈 0.05）.The endometrial thickness on the day of embryo transfer,implantation rate,clinical pregnancy rate and live birth delivery rate showed no statistical difference in the frozen-thawed embryo transfer cycles between the two groups（P〉0.05）.Conclusions：Oral contraceptive pretreatment has the negative effects on clinical pregnancy rate and live birth rate in the fresh cycle,which might be an effect on endometrial thickness,but no effect on clinic pregnancy outcome in frozen-thawed embryo transferred cycle as compared with spontaneous ovulation in long GnRH agonist protocol.