长方案与温和刺激方案在不同获卵数中的临床研究

Study of GnRH Agonist Long and Mild Stimulation Protocols in Different Number of Oocytes

目的:研究长方案与温和刺激方案在不同获卵数中的应用情况,探讨有效的、适合个性化的促排卵方案。方法:选择进行体外受精—胚胎移植(IVF-ET)的1560例无输卵管积液、无子宫内膜息肉及无子宫解剖结构异常等的患者为研究对象,按获卵数分为3组:A组获卵数≥18个(98例),B组获卵数5～17个(1219例),C组获卵数≤4个(243例)。分别比较各组中使用长方案和温和刺激方案患者移植情况及妊娠结局。结果:在A组和C组中长方案和温和刺激方案的优质胚胎率、临床妊娠率、流产率差异均无统计学意义(P>0.05),而在这2组中长方案使用促性腺激素(Gn)的量和天数均比温和刺激方案显著增多(P<0.05),而A组中长方案发生卵巢过度刺激综合征(OHSS)率高于温和刺激方案(P<0.05),C组两种方案均无一例发生OHSS。在B组中,长方案与温和刺激方案相比,使用Gn的量和天数均比温和刺激方案显著增多(P<0.05),但是长方案的临床妊娠率和受精率显著高于温和刺激方案(P<0.05)。结论:在体外受精-胚胎移植中获卵数适中者更适合使用长方案,然而获卵数多者和获卵数少者使用温和刺激方案,是一种经济的、有效的、有利于患者的促排卵方案。

Objective： To observe the clinical features and outcome of GnRH agonist long and mild stimulation protocols in different number of oocytes,explore appropriate individualized protocols effectively. M ethods： All the ET patients,without tubal fluid,endometrial polyps and anatomical abnormalities of the uterus,were assigned into three groups based on the number of retrieved oocytes,the number of oocytes in group A is ≥18（ n = 98）,in group B is 5- 17（ n = 1219）,in group C is≤4（ n = 243）. Compare basic features and clinical outcome of patients in each group between different stimulation protocols. Results： In all groups,the dose and duration of GnRH agonist long protocols were significantly higher than mild protocols（ P 〈0. 05）. The good quality embryo rates,clinical pregnancy rates and abortion rates in two protocols were similar in the group A and group C（ P 〈0. 05）. The OHSS rate of the mild stimulation protocols was significantly lower than long protocols in Group A（ P 〈0. 05）,while there was no case of OHSS happened in group C. In group B,clinical pregnancy rates and fertilization rate of long protocols were significantly higher than mild protocols（ P 〈0. 05）. Conclusions： In vitro fertilization-embryo transfer GnRH agonist long protocol is more appropriate for the moderate number of oocytes group,while the mild stimulation protocols is an economical effective protocol for small or large number of oocytes group.