体外受精超促排卵治疗中单用促性腺激素和拮抗剂方案临床结局的比较

Comparison of clinical outcomes in in vitro fertilization(IVF) cycles with gonadotrophin alone or in association with GnRH antagonist

目的探讨体外受精(IVF)治疗中单用促性腺激素(Gn)对妊娠结局的影响。方法月经第3日开始给予重组卵泡刺激素(rFSH)促排卵,促排卵第6日开始监测血激素水平和阴道超声监测卵泡大小。将达到思则凯添加标准者[黄体生成素(LH)>5 IU/L,或LH/基础LH≥3]设为对照组,每日给予思则凯0.125 mg直至人绒毛膜促性腺激素(hCG)注射日;以未达到标准不使用思则凯者设为研究组。结果研究组(n=31)和对照组(n=49)患者在Gn剂量、促排卵天数、hCG注射日血清内分泌水平、获卵数、受精率、着床率、临床妊娠率和活产率方面均无统计学差异(P>0.05)。结论在IVF促排卵治疗中,通过对血清LH的监测,如果LH维持在低水平可以不给予拮抗剂治疗,单纯使用Gn是一种经济有效的促排卵方案。

Objective To analyze the clinical outcomes in in vitro （IVF） cycles with gonadotrophin alone.Methods Women undergoing their first IVF/ intracytoplasmic sperm injection （ICSI） cycles with gonadotropin （Gn） alone or in association with Gn antagonist were enrolled in this study. Ovarian hyperstimulation was starting on menstrual day 3 with recombination follicle stimulating hormone （rFSH）. Serial vaginal ultrasound examination was performed and hormone levels were measured every other day from stimulation day 6. The patients with luteinizing hormone （LH）≤ 5 IU/L, or LH/basal LH ratio 〈3 received Gn alone as study group. For the patients with LH〉5 IU/L, or LH/basal LH ratio≥3, 0.125 mg Centrotide was administered daily till human chorionic gonadotrophin （hCG） injection day, namely control group.Results Totally 80 patients were enrolled, including 31 patients in study group, and 49 patients in control group. There were no statistically differences between the two groups in clinical pregnancy rate and live birth rate （P〉0.05）. The duration of stimulation, FSH dosage, the hormone levels on hCG injection day were also comparable.Conclusion Omitting administration of GnRH antagonist might be a cost-effective measure for patients without elevated LH during controlled ovarian hyperstimulation （COH）.