不同剂量长效促性腺激素释放激素降调节对体外受精-胚胎移植结局的影响

Effect of different doses of long acting gonadotropin releasing hormone on pregnancy outcome of in-vitro fertilization and embryo transfer

目的探讨长方案中不同剂量促性腺激素释放激素激动剂(GnRH-a,达菲林)降调节对体外受精-胚胎移植(IVF-ET)结局的影响。方法按GnRH-a剂量不同,将311例接受IVF-ET行长方案治疗患者分为4组,其中A组47例达菲林剂量为0.8 mg,B组89例达菲林剂量为1 mg,C组99例达菲林剂量为1.1 mg,D组76例达菲林剂量为1.25 mg。比较4组超促排卵各参数[促性腺激素(Gn)使用时间、Gn用量、HCG日内膜厚度、HCG日内膜形态、移植日内膜厚度、获卵数、MII率]及IVF-ET结局。结果 A、B、D组Gn使用时间比较差异均无统计学意义(P均>0.05),但C组Gn使用时间明显长于A组(P<0.05);D组Gn用量明显小于A、B、C组(P均<0.05);B组移植日子宫内膜厚度大于C、D组(P均<0.05);B、C、D组获卵数均明显多于A组(P均<0.05),且D组明显多于B组(P<0.05);A组ICSI受精率明显高于C组和D组(P均<0.05),2PN率明显高于B、C、D组(P均<0.05);D组妊娠率明显高于A组(P<0.05)。4组其余指标比较差异均无统计学意义(P均>0.05)。结论增加GnRH-a剂量不会明显增加Gn用量,子宫内膜厚度会维持在适宜的水平,妊娠率提高,获得良好的妊娠结局。达菲林1.25 mg降调节结局优于0.8 mg。

Objective It is to investigate the effect of different doses of gonadotropin releasing hormone agonist on the out- come of in - vitro fertilization and embryo transfer （ IVF - ET）. Methods 311 patients with long protocol were divided into A, B, C, and D four groups according to the dose of gonadotropin releasing hormone. Among them, the A group was 47 cycles u- sing gonadotropin releasing hormone （ GnRH - a） 0.8 rag, B group of 89 cycles of GnRH - a dose was 1 mg, C group of 99 cy- cles using GnRH - a 1.1 rag, D group of 76 groups GnRH - a dose of 1.25 mg. Gonadotropin （Gn） time, Gn dose, the num- ber of eggs and the corresponding IVF - ET outcome were compared among the four groups. Results Gn used time had no sig- nificant difference in A, B, D group （P 〉 0.05） ,but the time in C group was longer than that in A group. Gn dosage of D group was less than that in A, B, C group（P 〈0.05） ;The Endometrial thickness of B group was thicker than that in C and D groups （ P 〈 0.05 ） on the day of transplantation ; D group obtained more oocytes than B group （ P 〈 0.05 ） ; There was no sig- nificant difference between the four groups （ P 〉 0.05 ） in the IVF fertilization rate ; ICSI fertilization rate of B group was higher than that of C group, and C group was higher than D group ; The rate of 2PN in group A was significantly higher than that in B, C and D groups （P 〈 0.05） ; The pregnancy rate of D group was significantly higher than that of A group （P 〈 0.05 ）. There was no significant difference between the four groups （P 〉 0.05 ） in the multiple pregnancy rate and abortion rate（ P 〉 0.05 ）. Conclusion Increasing the dose of GnRH - a does could not significantly increase the amount of Gn, endometrial thickness will remain at the appropriate level,pregnancy rate is improved, and good pregnancy outcome is obtained. The dose of 1.25rag in the pituitary of the rectangular case was superior to 0.8mg.