GnRH激动剂长效剂型的两种促排卵方案在PCOS患者中的应用

Application of two long protocols with long-acting GnRH agonist for ovarian stimulation in PCOS patients

目的比较GnRH激动剂(GnRH-a)长效剂型的两种促排卵方案在PCOS患者中的治疗结局。方法回顾性分析2015年1月至2016年6月在我院行IVF/ICSI-ET治疗的PCOS患者,根据使用长效GnRH激动剂方法的不同分为两组:改良超长方案组(A组,周期数223),减量长效长方案组(B组,周期数200),比较两组患者的一般资料、促排卵情况及种植率、临床妊娠率、早期流产率、抱婴率、中重度OHSS发生率等临床结局差异。结果两组患者的一般情况、基础激素水平和促排卵药物Gn量、HCG日LH、E_2、获卵数均无统计学差异(P>0.05);A组的种植率(50.64%vs.40.91%)、临床妊娠率(67.28%vs.55.48%)、抱婴率(60.49%vs.45.89%)均显著高于B组(P<0.05),而早期流产率(5.50%vs.9.88%)显著低于B组,差异均有统计学意义(P<0.05);A组的OHSS中重度发生率(2.24%vs.2.0%)、2PN受精率(58.23%vs.57.31%)、卵裂率(95.85%vs.95.01)、优胚率(38.23%vs.37.15%)均略高于B组,但差异无统计学意义(P>0.05)。结论与GnRH-a减量长效长方案相比,在PCOS患者中GnRH-a改良超长方案可显著改善妊娠结局,且未增加中重度OHSS发生率,可以为PCOS的治疗提供选择。

Objective： To compare the clinic outcomes of two controlled ovarian stimulation （COS） protocols with long-acting GnRH agonist （GnRHa） in patients with polycystic ovary syndrome （PCOS）. Methods： The data of PCOS patients undergone IVF/ICSI treatment including 423 cycles from January 2015 to June 2016 were retrospectively analyzed. The cycles were divided into two groups according to the regimen of long acting GnRHa used： the patients were used modified super-long GnRH agonist protocol in group A （n= 223） ,and the patients were used low-dose long-acting GnRH agonist long protocol in group B （n = 200）. The general conditions, basic hormone levels, ovulation induction and pregnancy outcomes including implantation rate, ciinical pregnancy rate, early abortion rate,birth rate and incidence of moderate and severe ovarion hyperstimulation syndrome （OHSS） were compared between the two groups. Results： There were no significant differences in the general conditions, basic hormone levels, total amount of Gn used, E2 ＆ LH levels on HCG day and the number of oocytes retrieval between the two groups （P〉0.05）.The implantation rate （50.64% vs. 40.91%）, clinical pregnancy rate （67.28% vs. 55.48%）,birth rate （60. 49 % vs. 45.89%） in group A were significantly higher than those in group B. The early abortion rate （5.50% vs. 9.88%） in group A was significantly lower than that group B （P〈0.05）. The moderate and severe OHSS incidence in group A was slightly higher than that in group B （2.24%vs. 2.0%） ,but the difference was not significant （P〉0.05）. The 2PN fertilization rate（58.23% vs. 57.31%）,cleavage rate（95.85% vs. 95.01%） and high quality embryos rate（38.23% vs. 37.15%） in group A were higher than those in group B,but the differences were not significant（all P〉0.05）. Conclusions： Compared with low-dose long-acting GnRH-a protocol,the modified super-long GnRH-a protocol can improve the clinical pregnancy outcome but not increase the incidence of moderate and severe OHSS,which can provide a choice for the treatment of PCOS.