GnRH-a长效降调节和短效降调节长方案在体外受精周期中临床应用价值的比较

Comparison of clinical application value of GnRH-a long-acting down-regulation protocol and short-acting down-regulation long protocol in IVF/ICSI cycles

目的探讨长效和短效促性腺激素释放激素激动剂(GnRH-a)垂体降调节长方案对体外受精-胚胎移植(IVFET)结局的影响。方法回顾性分析采用黄体期GnRH-a降调解长方案进行控制性促排卵(COH)的患者235例,并根据使用GnRH-a的剂量分为两组。长效GnRH-a组120例,于黄体中期采用长效GnRH-a 1.25 mg皮下注射1次;短效GnRH-a组115例,于黄体中期采用短效GnRH-a 0.05 mg每日皮下注射1次直至注射绒膜促性腺激素(h CG)注射日。比较两组间垂体降调节效果、促排卵过程中激素水平、促性腺激素(Gn)使用剂量、时间及IVF-ET的结局。结果短效GnRH-a组与长效GnRH-a组相比垂体降调节天数较长,Gn使用天数及总剂量降低,分别为[(14.26±0.869)d和(12.64±2.024)d],[(9.85±1.98)d和(12.28±2.58)d]及[(1 808.58±602.06)u和(2 316.16±929.87)u],差异有统计学意义(P<0.01);短效GnRH-a组Gn启动日及h CG日LH水平明显高于长效GnRH-a组,分别为[(1.87±0.76)U/L和(1.53±0.92)U/L,P<0.05]及[(2.02±1.08)d和(0.993±0.766)U/L,P<0.01];两组间受精率、卵裂率、胚胎种植率、临床妊娠率及流产率差异均无统计学意义(P>0.05),长效GnRH-a组OHSS发生率高于短效GnRH-a组,差异有统计学意义(P<0.05)。结论长效GnRH-a组垂体抑制过深,在COH过程中LH水平偏低,导致Gn的用量增加,OHSS发生率增高,短效组卵泡质量高。

Objective To explore the effects of long-acting and short-acting gonadotropin-releasing hormone agonist（ GnRH-a）down-regulation long protocol on outcome of in vitro fertilization and embryo transfer（ IVF-ET）.Methods A total of 235 patients receiving GnRH-a down-regulation long protocol during luteal phase for controlled ovarian hyperstimulation（ COH） were analyzed retrospectively,then they were divided into two groups according to GnRH-a dose.A total of 120 patients in long-acting GnRH-a group were treated by intramuscular injection of long-acting GnRH-a（ 1.25 mg） during mid-luteal phase for one times;115 patients in short-acting GnRH-a group were treated by intramuscular injection of short-acting GnRH-a（ 0.05 mg） during mid-luteal phase until the day of human chorionic gonadotropin（ h CG） injection.The effects of down-regulation,hormones levels during COH,application doses and time of gonadotrophin（ Gn）,and IVF-ET outcomes were compared between the two groups.Results Compared with long-acting GnRH-a group,the time of down-regulation was longer in short-acting GnRH-a group,application time and total dose were lower [（ 14.26±0.869） days vs.（ 12.64±2.024）days,（ 9.85±1.98） days vs.（ 12.28±2.58） days,（ 1 808.58±602.06） U vs.（ 2 316.16± 929.87） U],there were statistically significant differences（ P〈0.01）.The levels of LH on the day of Gn start and h CH injection in short-acting GnRH-a group were higher than those in long-acting GnRH-a group [（ 1.87±0.76） U/L vs.（ 1.53±0.92） U/L,（ 2.02±1.08） days vs.（ 0.993±0.766） U/L],there were statistically significant differences（ P〈0.05,P〈0.01）.There was no statistically significant difference in fertilization rate,cleavage rate,embryo implantation rate,clinical pregnancy rate,and abortion rate between the two groups（ P〉 0.05）.The incidence rate of ovarian hyperstimulation syndrome（ OHSS） in long-acting GnRH-a group was statistically significantly higher than that in short-acting GnRH-a group（ P〈0.05）.Conclusion Long-acting GnRH-a suppresses pituitary strongly,which results in low level of LH during COH,high application dose of Gn,and high incidence rate of OHSS.The quality of follicles in short-acting GnRH-a group is high.