促性腺激素释放激素拮抗剂方案与激动剂长方案应用于新鲜胚胎移植患者的疗效比较

Efficacy comparison of GnRH antagonist protocol and GnRH long protocol for the patients undergoing fresh embryo transfer

目的:比较新鲜胚胎移植患者使用促性腺激素释放激素(GnRH)拮抗剂方案和GnRH激动剂长方案进行超促排卵的效果。方法:回顾性分析进行新鲜胚胎移植患者的临床资料。比较采用GnRH激动剂长方案与GnRH拮抗剂方案患者的超促排卵反应和新鲜胚胎妊娠结局。结果:共纳入706例,其中超促排卵时637例使用GnRH激动剂长方案,69例患者使用GnRH拮抗剂方案。拮抗剂组患者促性腺激素(Gn)使用时间[(10.55±1.38)d vs(11.20±1.84)d]和剂量[(1 699.50±611.25)Uvs(2 196.75±765.75)U]均明显少于激动剂组(P<0.05)。拮抗剂组平均获卵数[(12.11±5.20)枚vs(9.69±3.86)枚]和MⅡ卵数[(10.15±4.65)枚vs(8.26±3.50)枚]多于激动剂组(P<0.05)。而两组子宫内膜厚度、受精率、种植率和临床妊娠率差异无统计学意义。结论:对于新鲜胚胎移植患者,使用GnRH拮抗剂方案进行超促排卵可获得较多的优质胚胎数,但临床妊娠率未体现优势。

Objective：To compare the clinical effect between gonadotrophin-releasing hormone （GnRH） antagonist protocol and GnRH agonist long protocol in patients obtaining fresh embryo transfer.Methods：Clinical data of patients in the fresh embryo transfer cycle were analyzed retrospectively.Main clinical outcomes including superovulation and pregnant rates were compared.Results：A total of 706 cases were selected, 637 patients received GnRH agonist long protocol, and 69 patients received antagonist protocol.Compared with agonist group, the patients in antagonist group had significantly shorter duration of gonadotropin （[10.55±1.38] d vs [11.20±1.84] d）, fewer doses （[1 699.50±611.25] U vs [2 196.75±765.75] U, P〈0.05）, more oocytes （12.11±5.20 vs 9.69±3.86, P〈0.05）, and more MⅡoocytes （10.15±4.65 vs 8.26±3.50, P〈0.05）.However, there was no significant difference in thickness of endometrium, fertilization rate, implantation rate, and pregnant rate between the two groups.Conclusions：Compared with the long GnRH agonist protocol, the GnRH antagonist protocol can bring out a substantial increase in the number of good quality embryos among the patients receiving fresh embryo transfer, but shows no advantage in pregnant rate.