微量GnRH-a长方案和短方案在≥35岁不孕患者IVF/ICSI-ET中临床结局的比较

Mini-dose Gn RH-a long versus short protocol in patients ≥ 35 years old undergoing in vitro fertilization and embryo transfer

目的：比较高龄不孕女性体外受精／卵胞质内单精子显微注射一胚胎移植（IVF／ICSI-ET）中微量短效GnRH-a长方案及常规短方案的促排卵效果及临床结局。方法：回顾性分析602例≥35岁不孕患者682个周期IVF／ICSI-ET临床结局，按促排卵方案分为微量短效GnRH-a长方案组（172个周期，A组）和常规短方案组（510个周期，B组），再以年龄段分层（35～37岁，38～39岁及≥40岁），分别比较不同年龄段两种促排卵方案的效果及临床结局。结果：A组Gn用量、Gn使用天数显著高于B组（P〈0．05），MⅡ卵数、优质胚胎率、胚胎移植数、周期取消率均无统计学差异（P〉0．05）；A组与B组相比，临床妊娠率、活产率（36．1％坩29．8％；28．5％vs 23．3％；P〉0．05）有改善趋势；尤其在35～37岁及38～39岁患者中，A组优质胚胎率、临床妊娠率、活产率（52．89％vs 47．16％，50．14％ vs 47．97％；41．7％ vs 36．7％，36．4％ vs 22．2％；35．0％ vs 29．2％，24．2％ vs 15．7％；P均〉0．05）均有明显改善趋势。结论：≥35岁不孕女性微量GnRH-a长方案临床结局有改善趋势，可作为高龄不孕女性，尤其是35～39岁不孕患者的有效促排卵方案之一。

Objective： To compare the clinical outcomes of mini-dose GnRH-a long protocol with short protocol in aged patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer （IVF/ ICSI-ET）. Methods： A total of 682 cycles of 602 women undergoing IVF/ICSI-ET aged above 35-year-old were retrospectively analyzed. Patients were assigned to mini-dose GnRH-a long protocol （group A, 172 cycles）, and GnRH-a short protocol （group B, 510 cycles）. The efficacy of induced ovulation and pregnancy outcome were compared between the two groups, and further comparison was conducted according to the age （35-37 years, 38- 39 years, and≥ 40 years）. Results： Gn dose and Gn duration were significantly higher in group A than in group B （P〈0.05）. Both groups showed similar clinical pregnancy rate and live birth rate. Among patients aged 35- 37 years and 38-39 years, the good-quality embryo rate （52.89% vs 47.16%, 50.14% vs 47.97%）, the clinical pregnancy rate （41.7% vs 36.7%, 36.4% vs 22.2%） and the live birth rate （35.0% vs 29.2%, 24.2% vs 15.7%） were higher in group A than in group B, though not statistically significant. Conclusion： Mini-dose GnRH-a long protocol for aged women is at least as effective as short protocol, especially in patients aged 35-39 years, with a tendency of higher clinical pregnancy rate and live birth rate, therefore mini-dose GnRH-a long protocol can be considered as an alternative protocol for patients above 35 years old.