高纯度人绝经期促性腺激素在促排卵治疗中的应用研究

Application of high purity HMG in controlled ovarian stimulation

目的探讨高纯度人绝经期促性腺激素(HP-HMG)在体外受精-胚胎移植(IVF-ET)促排卵治疗中的有效使用方法。方法回顾性分析2013年1月5日至10月30日于中信湘雅生殖与遗传专科医院行IVF-ET助孕的298名患者的临床资料,根据促排卵药物的不同分成2组:单纯使用HP-HMG的138人为第1组,使用重组FSH(rFSH)和HP-HMG的160人为第2组。比较两组患者促排卵过程中卵巢反应、激素水平、用药情况及治疗结局。结果第2组Gn第6天的E2水平[(2 923.06±430.64)pmol/L]显著高于第1组[(2 218.44±1 745.86)pmol/L](P<0.05)。第1组HCG日及Gn第6天HCG水平、总Gn用量和Gn天数明显高于第2组[(分别为(1.79±0.78)U/L vs.(0.89±0.59)U/L,(1.38±1.03)U/L vs.(0.48±0.35)U/L,(1 623.02±547.08)U vs.(1 287.53±498.58)U,(9.89±1.57)d vs.(9.35±1.48)d](P<0.05)。两组患者的平均获卵数、受精数、优胚数、早期流产率、取消率、中重度卵巢过度刺激综合征(OHSS)发生率、OHSS取消率、宫外孕发生率比较均无显著性差异(P>0.05)。第2组患者的妊娠率、着床率和活产率显著高于第1组(分别为81.06%vs.67.29%,62.25%vs.46.60%,74.24%vs.59.81%)(P<0.05)。结论在IVF-ET治疗中,使用rFSH和HP-HMG联合促排卵可以获得比单纯应用HP-HMG较高的临床妊娠率。

Objective： To explore the effectiveness of application of high purity HMG（HP-HMG）in controlled ovarian stimulation.Methods： The data of 298 patients undergone IVF-ET in our hospital from Jan 5to Oct 30 2013 were retrospectively analyzed.The patients were divided to two groups：138patients used HP-HMG in group 1and 160 patients used recombinant（rFSH）and HP-HMG in group 2.The ovarian response,hormone levels,drug use and clinical outcome were compared between the two groups.Results： The E2 levels on the sixth day of ovarian induction [（2 923.06±430.64）vs.（2 218.44±1 745.86）pmol/L]in group 2were significantly higher than those in group 1（P〈0.05）.The HCG levels at the sixth day of ovarian induction[（1.38±1.03）vs.（0.48±0.35）U/L]or on HCG days [（1.79±0.78）vs.（0.89±0.59）U/L],the total dose of gonadotropin（Gn）used [（1 623.02±547.08）vs.（1 287.53±498.58）U]and duration of Gn used[（9.89±1.57）vs.（9.35±1.48）days]in group 1were significantly higher than those in group 2（P〈0.05）.There were no differences in number of oocytes retrieved,fertilization rate,number of high-quality embryos,early abortion rate,cancellation rate,incidence of moderate or severe ovarian hyperstimulation syndrome（OHSS）,OHSS cancellation rate and incidence of ectopic pregnancy between the two groups（P〉0.05）.The pregnancy rate（81.06% vs.67.29%）,implantation rate（62.25% vs.46.60%）and live birth rate（74.24% vs.59.81%）in group 2 were significantly higher than those in group 1（P〈0.05）.Conclusions： The method of using rFSH combined with HP-HMG in controlled ovarian stimulation is worthy of recommended.