在IVF-ET中低剂量长效GnRH-a与短效GnRH-a长方案降调节的评价

Evaluation of long protocol with low dose of long-acting GnRH-a or short-acting GnRH-a in IVF-ET

目的回顾性分析低剂量长效GnRH-a与短效GnRH-a长方案对IVF-ET周期参数的影响,探讨该方案的安全性和有效性。方法回顾性分析2011年7月至12月在本院生殖医学中心进行IVF-ET治疗的1 928个周期资料,其中长效低剂量(0.375mg,0.8mg和1.0mg 3组)长方案1 093个周期,短效长方案835个。结果 (1)0.375mg组HCG日血清LH水平显著高于其它3组(P<0.05)。(2)HCG日血清E2水平在4组之间无差异;短效组血清孕酮(P)水平[(1.9±0.95)nmol/L]显著低于长效0.375mg,0.8mg和1.0mg 3组[(2.2±1.3)、(2.5±1.6)、(2.2±1.6)nmol/L](P<0.005)。(3)短效组和长效0.375mg组FSH启动剂量显著高于长效0.8mg和1.0mg两组(P<0.005);短效组FSH总量、HMG总量与Gn使用时间和平均获卵数均显著低于长效3组(P<0.005);(4)卵巢高反应发生率在0.8 mg(31.0%)和1.0 mg(31.9%)组显著高于0.375mg(18.2%)和短效组(15.7%);1.0mg组卵巢低反应率和取消移植率均显著低于其它3组(P<0.05)。(5)IVF-ET参数:1.0mg组获卵数、MⅡ卵母细胞数、受精数、可用胚胎数均显著高于其余3组,但MⅡ卵母细胞率、正常受精率无差异;0.8mg组卵母细胞利用率显著高于其它3组;1.0mg和0.8mg组临床妊娠率显著高于短效组和长效0.375mg组;长效1.0mg组种植率(35.4%)显著高于其它3组(27.6%、27.3%、28.1%)。结论血清LH水平与GnRHa剂型和剂量有关,短效GnRH-a组与0.375mg长效GnRH-a组呈现出相似的垂体不完全抑制作用,在卵巢水平对E2合成没有显著差别。低剂量长效GnRH-a降调节对IVF-ET结局的影响和机制还有待于前瞻随机对照研究进一步阐明。

Objective：To assess the effect of long protocol with low dose of long-acting GnRH-agonist（GnRHa）or short-acting GnRH-a on the parameters of IVF-ET,and efficacy and safety of the protocols.Methods：The data of 1 928IVF-ET cycles with triptorelin acetate in long-acting regimen（1 093cycles）and short-acting regimen（835cycles）from July 1st to December 31 st 2011in Reproductive Medical Center,the First Affiliated Hospital,Zhongshan University were retrospectively analyzed.The patients in long-acting regimen were subdivided into 3 subgroups with the dosage of 0.375,0.8 and 1.0 mg respectively.Results：The serum LH levels on HCG day in 0.375 mg group were significant higher than those in the other three groups（P〈0.05）.The serum progesterone（P）levels on HCG day in short-acting group[（1.9±0.95）nmol/L]were significant lower than those in 0.375 mg,0.8 mg or 1.0 mg of long-acting groups[（2.22±1.27）,（2.5±1.6）,（2.22±1.6）nmol/L]（P〈0.005）.However,the serum E2 levels on HCG day were not significantly different among the four groups（P〈0.05）.The initial doses of FSH in short-acting protocol or 0.375 mg group were significant higher than those in 0.8mg or 1.0mg group（P〈0.005）.The total doses of FSH HMG,the duration of gonadotropin（Gn）and average number of oocytes retrieved in short-acting protocol were significantly lower than those in the three long-acting groups（P〈0.005）.The ovarian high response rate in 0.8mg group（31.0%）or 1.0mg group（31.9%）was significantly higher than that in 0.375 mg group（18.2%）or the short-acting group（15.7%）（P〈0.05）.The ovarian low response rate and the cycle cancellation rate in 1.0 mg group was significantly lower than those in the other three groups（P〈0.05）.The number of oocytes retrieved,number of MII oocyte and fertilization,and number of available embryos in 1.0 mg group were significantly higher than those in the other three groups（P〈0.05）,but the MII oocyte rate and normal fertilization rate were not significantly different（P〈0.05）.The oocyte utilization rate in 0.8mg group was significantly higher than that in the other three groups（P〉0.05）.The clinical pregnancy rate in 0.8 mg or 1.0group was significantly higher than that in short-acting protocol or 0.375 mg group（P〈0.05）.The implantation rate in 1.0mg group（35.4%）was significantly higher than that in the other three group（27.6%,27.3% and28.1%）respectively（P〈0.05）.Conclusion：Serum LH level is related with formulation and dosage of GnRH-a.The desensitization of pituitary effect in 0.375 mg long-acting group is similar with short-acting group,and the effect on synthesis of E2 is also not significantly different.The efficacy and safety of the low dose of long-acting GnRH-a protocol in IVF-ET should be clarified by prospectively randomize study in the future.