增加垂体降调节时间和GnRH-a剂量改善IVF/ICSI-ET妊娠率和活产率

Prolonging pituitary down-regulation time and increasing GnRH agonist dose can improve pregnancy rate and live-birth rate of IVF

目的探讨延长促性腺激素释放激素激动剂(GnRH-a)降调节时间和增加GnRH-a剂量对IVF/ICSI-ET妊娠率和活婴分娩率的影响。方法回顾性分析4 941例采用短效GnRH-a长方案降调节的IVF/ICSI-ET周期临床资料。根据GnRH-a使用剂量及降调节时间不同分为A1(GnRH-a 0.05mg/d,<20d)、A2(GnRH-a 0.05mg/d,>20d)、B1(GnRH-a0.1mg/d,<20d)和B2组(GnRH-a 0.1mg/d,>20d)。比较4组患者的促性腺激素(Gn)剂量、种植率、妊娠率和活婴分娩率。结果 B2组降调节天数和种植率、妊娠率和活婴分娩率显著高于其他3组(P<0.05),而Gn剂量显著少于其他3组(P<0.05)。结论在使用短效GnRH-a长方案垂体降调节中,通过延长Gn启动前GnRH-a降调节时间、增加GnRH-a使用剂量可以改善IVF-ET妊娠率和活婴分娩率,且未显著增加Gn使用剂量。

Objective： To evaluate the effects of a prolonging administration time of GnRH agonist （GnRH a） in pituitary down regulation for controlled ovarian hyperstimulation （COH） on the pregnancy rate and live birth rate in women undergone IVF-ET. Methods： In this retrospective study,4 941 IVF/ICSI-ET cycles were divided to four groups according the days of down regulation and the dose of GnRH a before using gonadotropin （Gn） ： group A1 （GnRH a 0.05 mg/day,〈20 days）,A2 （GnRH a 0.05 mg/day,〉20 days）,B1 （GnRH a 0.1 mg/day,〈20 days） and group B2 （GnRH-a 0.1 mg/day,〉20 days）. The Gn dose,implantation rate,pregnancy rate and livebirth rate were compared among the groups. Results： The dosage of Gn was significantly less, but the administration days of Gn, implantation rate, pregnancy rate and the live birth rate were significantly higher in group B2 than those in group A1, A2 and B1 （all P〈0.05）. Conclusions： Prolonging pituitary down-regulation time and increasing GnRH agonist dose can improve the pregnancy rate and the live birth rate in IVF treatment, however, the dose of Gn used is not increased.