拮抗剂方案中应用促性腺激素释放激素激动剂联合人绒毛膜促性腺激素诱导卵泡成熟的结局分析

Analysis of outcome between combined trigger of GnRHa and hCG and single trigger of hCG using GnRHa antagonist protocol

目的:探讨拮抗剂方案中联合应用促性腺激素释放激素激动剂(Gn RHa)及人绒毛膜促性腺激素(h CG)在接受体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的患者中诱导卵泡成熟的疗效。方法:共纳入拮抗剂方案促排卵行IVF/ICSI的不孕症患者392例,根据诱导卵泡成熟方法分为Gn RHa联合h CG组(A组,194例)及单用h CG组(B组,198例),观察并计算胚胎情况、妊娠结局及中重度卵巢过度刺激综合征(OHSS)发生率。结果:患者年龄、基础FSH水平、窦卵泡数、促性腺激素(Gn)总使用天数和h CG注射日雌二醇(E2)水平组间差异无统计学意义(P>0.05),A组的卵子成熟率显著高于B组(P<0.05);A组的双原核(2PN)受精率、第3日(D3)优质胚胎率及囊胚形成率均高于B组,差异无统计学意义(P>0.05);生化妊娠率、临床妊娠率、活产率及中重度OHSS发生率组间差异均无统计学意义(P>0.05)。结论:拮抗剂方案中联合应用Gn RHa及h CG诱导卵泡成熟可改善卵子成熟度,进而可能改善胚胎质量。

Objective： To investigate the effect of combined trigger of gonadotropin releasing hormone agonist （GnRHa） and human chorionic gonadotropin （hCG） in final follicular maturation in patients undergoing in vitro fertilization/intracytoplasmic sperm injection （IVF/ICSI）. Methods： This study included 392 infertile patients who underwent controlled ovarian hyperstimulation using GnRH antagonist protocol and IVF/ICSI treatment. Based on different kinds of trigger, they were divided into two groups： GnRHa combined with hCG （group A） and only hCG （group B）. The gamete and embryo situation, pregnancy outcome and ovarian hyperstimulation syndrome （OHSS） rate were compared between the two groups. Results： There were no statistical differences in ages, basal FSH, antral follicle count, duration of Gn stimulation and E2 level on trigger day between groups A and B （P〉0.05）. The MH oocyte rate in group A was significantly higher than that in group B （P〈0.05）. The 2PN fertilization rate, the day 3 （D3） high-quality embryo rate and the blastocyst formation rate in group A were higher than those in group B, though the differences were not statistically significant （P〉0.05）. There were no differences with regard to biochemical pregnancy rate, clinical pregnancy rate, live birth rate and moderate and severe OHSS rate between the two groups （P〉0.05）. Conclusion： Combined application of GnRHa and hCG to induce follicular maturation can improve oocyte maturation, and probably lead to improvement of embryo condition.