促性腺激素释放激素激动剂长、短方案在体外受精胚胎移植中的比较性研究

A prospective, randomized controlled study comparing the effects of gonadotropin-releasing hormone agonist long and short protocols for in vitro fertilization

目的 探讨促性腺激素释放激素激动剂 (GnRH a)长、短方案控制性超排卵在体外受精 胚胎移植 (IVF ET)中的疗效。方法 将 2 0 0 0年 1～ 5月进行IVF和单精子卵胞浆注射 (ICSI)助孕的不孕患者 ,按病历奇、偶数编号分为GnRH a长方案组 (5 5例 )和短方案组 (5 4例 )。长方案组从使用促性腺激素 (Gn)治疗周期前的黄体中期开始使用GnRH a 0 9mg/d ,至垂体完全降调节后 ,加用Gn ;短方案组从月经第 2天开始使用GnRH a 0 45mg/d ,同时加用Gn。两组均在优势卵泡达 18mm时 ,肌内注射人绒毛膜促性腺激素 (hCG) ,36h后取卵行IVF及ICSI。结果 长方案组较短方案组 ,使用Gn前血清促卵泡激素 (FSH)和黄体生成素 (LH)水平降低 [(4 4± 1 2 )IU/L比 (6 3± 1 7)IU/L ,(2 7± 1 5 )IU/L比 (4 4± 2 8)IU/L ,P <0 0 1];注射hCG前血清雌二醇 (E2 )和LH水平降低 [(7119± 35 84)pmol/L比(9 5 2 3± 35 87)pmol/L ,(1 0± 1 0 )IU/L比 (4 0± 3 4)IU/L ,P <0 0 1];每个卵子E2 水平降低 [(6 10±315 )pmol/L比 (935± 45 0 )pmol/L ,P <0 0 1];Gn用量增多 [(2 8 0± 8 6 )支比 (2 3 4± 8 7)支 ,P<0 0 1],用药时间增长 [(11 1± 1 2 )d比 (10 1± 1 5 )d ,P <0 0 1];两组平均获卵数、第 2次成熟分裂中期卵子数、

Objective To compare the effects of gonadotropin releasing hormone agonist (GnRH a) long and short protocols as part of in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment. Methods One hundred and nine infertile couples accepted a prospective, randomized comparative study for IVF or ICSI treatment were divided into GnRH a long protocol group (55 cases) and GnRH a short protocol group (54 cases). GnRH a long protocol group: GnRH a was taken by nasal spray 0 9 mg/day starting on day 21 of the previous menstrual cycle. Once the patient was down regulated, gonadotropin (Gn) injection was started. GnRH a short protocol group: GnRH a was taken by nasal spray 0 45 mg/day starting on day 2 of the menstrual cycle, and Gn was started on the same day. Two groups had human chorionic gonadotrophin (hCG) administered when the leading follicle was at least 18 mm in diameter. Oocytes were retrieved 36 hours after hCG administration guided by transvaginal ultrasounography. IVF/ICSI were performed as routine. Results Serum follicle stimulating hormone and luteinizing hormone (LH) levels on the day of starting Gn were lower in the long protocol group comparing with the short protocol group [(4 4±1 2) IU/L Vs (6 3±1 7) IU/L, (2 7±1 5) IU/L Vs (4 4±2 8) IU/L, P <0 01 respectively]. The levels of serum estradiol (E 2), LH and E 2 per oocyte on the day of hCG injection were lower in the long protocol group comparing with the short protocol group [ (7 119± 3 584) pmol/L Vs (9 523± 3 587) pmol/L, (1 0±1 0) IU/L Vs (4 0±3 4) IU/L, (610±315) pmol/L Vs (935±450) pmol/L, P <0 01 respectively]. Patients treated with short protocol were stimulated for a shorter period, required fewer Gn ampoules than the long protocol group [(10 1±1 5) d Vs (11 1±1 2) d, (23 4±8 7) Amps Vs (28 0±8 6) Amps, P <0 01 respectly]. There are no statistically differences between the two groups in the numbers of oocytes retrieved, metaphase of second meiosis oocytes, fertilized oocytes, cleaved embryos, high quality embryos and pregnancy rates. Conclusions The GnRH a long and short protocols have equal effects on controlled ovarian hyperstimulation for in vitro fertilization. Patients who received GnRH a short protocol required fewer ampoules of gonadotrpins and shorter period of treatment than those who received the GnRH a long protocol.