早卵泡期长效长方案中Gn剂量与临床结局之间的关系探讨

Discuss the relationship between IVF-ET clinical outcoms and Gn dose of long protocol

目的探讨早卵泡期长效长方案中促性腺激素（gonadotropin,Gn）的剂量与临床结局之间的关系,以明确在早卵泡期长效长方案中是否存在超促排卵的最佳Gn剂量范围。方法选取2014年6月~2015年11月在我院生殖中心行IVF-ET助孕的患者,年龄20~35岁,卵巢反应预测正常（8≤双侧窦卵泡数≤15,基础FSH≤10）。均采用早卵泡期长效长方案降调节,根据临床经验按其超促排卵过程中所用促性腺激素总量的差异将其分为四组,A组：Gn总量≤1200IU;B组：1200 IU〈Gn总量≤2400 IU;C组：2400 IU〈Gn总量≤3600 IU;D组：Gn总量〉3600 IU。分别比较四组之间一般临床特征、Gn总量、HCG日血清性激素水平、HCG日子宫内膜厚度、获卵数、2PN受精率、优胚率、种植率、临床妊娠率、中重度OHSS发生率等的差异。结果四组患者间的一般临床特征、2PN受精率、优质胚胎率,差异无统计学意义（P〉0.05）;Gn总天数、HCG日LH水平、HCG日P水平、HCG日E2水平,平均获卵数之间,差异有统计学意义（P〈0.05）,四组患者种植率A组≈B组〉C组〉D组,临床妊娠率A组〉B组〉C组〉D组,全胚冷冻率B组〉A组〉C组〉D组,差异有统计学意义（P〈0.05）;早期流产率C组〉B组〉A组〉D组,中重度OHSS率B组〉A组〉C组,但组间差异无统计学意义。结论早卵泡期长效长方案中Gn总剂量在2400IU以下的患者Gn天数少,临床妊娠率和种植率高。

Objective Discuss the relationship between IVF-ET clinical outcoms and Gn dose of long protocol in order to know if it is have the best dosage range.Methods From June 2014 to November 2015 in our hospital reproductive center IVF-ET help pregnant patients,aged 20 to 35 years old,the ovarian response prediction of normal（8 bilateral sinus follicle number is less than or equal to 15,FSH-10）.By the early follicular phase of long-term long down regulation,according to the clinical experience in superovulation in differences in gonadotropin amount will be divided into four groups,group A：the total Gn is less than or equal to 1200 IU;group B：1200IU〈Gn total less than 2400IU;group C：2400 IU〈Gn the total amount of less than 3600IU;group D：total Gn 〉3600IU.The comparison between the four groups respectively.The clinical characteristics,the total Gn and HCG on serum sex hormone levels and endometrial thickness on the day of HCG,the difference was 2PN oocytes,fertilization rate,good embryo rate,implantation rate,clinical pregnancy rate,the incidence of severe OHSS.Results Between the four groups in the general clinical features of 2PN,the fertilization rate,good embryo rate,the difference was not statistically significant（P〉0.05）;Gn,HCG,the total number of LH HCG level,P level,HCG E2 level,the average number of oocytes,the difference was statistically significant（P〈0.05）,four patients with planting rate the A group is B group,C group,D group,A group,the clinical pregnancy rate of B group,C group,D group,B group,the rate of total embryos frozen A group,C group,D group,the difference was statistically significant（P〈0.05）;early abortion rate of C group,B group,A group,D in severe OHSS group,B group,A group,the rate of C group,but no significant difference between the groups.Conclusion In long protocol,when the total amount of gonadotropins was less than2400 IU we had the highest clinical pregnancy rate and embryo implantation rate.