长效长方案垂体降调节后促性腺激素启动时机对助孕结局的影响

Effect of gonadotropin-initiated timing after pituitary down-regulation on outcome in longacting protocol

目的探讨长方案中长效促性腺激素释放激素激动剂(GnRH-a)垂体降调节后促性腺激素(Gn)的启动时间对体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕结局的影响。方法回顾性分析2015年1~12月在深圳武警医院生殖中心接受IVF/ICSI-ET(达菲林1.25mg长方案)治疗的3 853例患者资料,根据Gn启动前垂体降调节时间分成4组:A组≤14d;B组15~18d;C组19~23d;D组≥24d。比较各组的临床结局。结果四组患者间MⅡ卵率(ICSI周期)、卵裂率无统计学差异(P>0.05);从A组到C组,总Gn用量逐渐减少,D组Gn用量再次增加,A组与C组差异有统计学意义(P<0.05);A组获卵数、可利用胚胎数及着床率均显著低于其它组(P<0.05);C、D组优胚率显著低于B组(P<0.05);从A组到C组,临床妊娠率及活产率逐渐提高,D组略下降,A组与B、C组差异有统计学意义(P<0.05);B、C组流产率低于A、D组,但无统计学差异(P>0.05)。结论在长效GnRH-a长方案控制性促排卵周期中,适当延长Gn启动时间(15~23d)可能改善卵母细胞的质量和内膜容受性,从而提高临床妊娠率,降低胚胎早期流产率,同时可减少Gn用量,从而减轻患者经济负担。

Objective：To investigate the effect of gonadotropin（Gn）initial timing after pituitary down-regulation on the outcome in long lasting protocol of IVF/ICSI-ET treatment.Methods： The data of 3 853 patients treated with IVF/ICSI-ET（1.25 mg long acting GnRH-a）in Shenzhen Armed Police Hospital from January to December of 2015 were analyzed retrospectively.The patients were divided into four groups according to Gn initial timing after pituitary down-regulation time：group A≤14 days,group B 15-18 days,group C 19-23 days,group D≥24 days.The clinical outcomes were compared the groups.Results：There was no significant difference in MⅡ oocyte rate（ICSI）and cleavage rate among the four groups（P〉0.05）.From group A to group C,the total dosage of Gn used were decreased gradually,but increased in group D,the difference between group A and group C was significantly different（P〈0.05）.The number of oocytes retrieved,the available embryo rate and the implantation rate in group A were significantly lower than other groups（P〈0.05）.The good quality embryo rate of group C and group D was significantly lower than that of group B（P〈0.05）.From group A to group C,the clinical pregnancy rate and the live birth rate were gradually increased,and decreased slightly in group D.The difference wassignificant between group A and group B C（P〈0.05）.The rate of abortion in group B and C was lower than that in group A and D,but the difference was not significant（P〉0.05）.Conclusions：A properly extend Gn initiation time（15-23 days）may improve oocyte quality and endometrial receptivity in long acting protocol of controlled ovarian hyperstimulation,which may increase clinical pregnancy rate,but reduce early abortion rate,the amount of Gn used and the economic burden of patients.