个体化剂量长方案降调节在IVF-ET中的应用

Application of individual dosage of GnRH agonist in long down-regulation protocol in IVF treatment

目的回顾性分析不同剂量的长效GnRH-a降调节对IVF-ET治疗结局的影响,探讨针对不同人群的最佳降调节方案。方法回顾性分析2015年1~12月在本院生殖中心行IVF-ET治疗的3 639个周期的临床资料,根据给予GnRH-a剂量的不同分为:A组(0.50~0.70mg)41个周期,B组(0.75~0.80mg)589个周期,C组(0.90~1.10mg)64个周期,D组(1.25~1.40mg)2 873个周期,E组(1.80~2.50mg)41个周期,F组(3.75mg)31个周期。比较各组间促排情况、实验室结果及妊娠结局。结果 HCG日LH水平A组及B组显著高于D组及E组,HCG日E2水平D组显著高于A组、B组及C组,HCG日P水平D组显著高于B组(P<0.05)。Gn总用量各组间无显著差异(P>0.05);A组、B组及C组获卵数显著少于其余3组(P<0.05);ICSI的MⅡ卵母细胞率各组间比较无显著性差异(P>0.05);IVF-2PN率E组显著低于B组、C组及D组(P<0.05);可利用胚胎率F组显著低于其余各组(P<0.05);ICSI-2PN率、卵裂率及优胚率在各组间无显著差异(P>0.05)。首次移植临床妊娠率B组显著低于D组(P<0.005);着床率D组及F组显著高于A组及B组(P<0.05);全胚冷冻率D组显著高于B组及C组(P<0.005);活产率B组显著低于C组及D组,E组显著低于C组(P<0.05);平均移植胚胎数及流产率在各组间无显著差异(P>0.05)。结论根据患者实际情况给予个体化剂量的长方案降调节既能有效抑制早发LH峰,又能达到理想的降调水平,获得较好的妊娠结局。

Objective:To analyze the effect of different dosage of GnRH agonist(GnRH-a)in long down-regulation protocol in IVF treatment,in order to explore the best down-regulation protocol for different group of patients.Methods:The data of 3 639 IVF-ET cycles in our center from Jan.to Dec.in 2015 were retrospectively analyzed.The patients were divided into 6 groups according to the different dosage of GnRH-a used:group A(0.5-0.7 mg,n=41),group B(0.75-0.8 mg,n=589),group C(0.9-1.1 mg,n=64),group D(1.25-1.4 mg,n=2 873),group E(1.8-2.5 mg,n=41),group F(3.75 mg,n=31).The stimulation status,laboratory data and pregnancy outcome were compared among the groups.Results:The LH levels on HCG day in group A and B were significantly higher than those in group D and E(P<0.05).The E 2 levels on HCG day in group D were significantly higher than those in group A,B and C.The progesterone levels on HCG day in group D were significantly higher than those in group B(P<0.05).The gonadotropin(Gn)dosage were not different among the groups(P>0.05).The number of oocyte retrieved in group A,B and C was significantly less than the other three groups(P<0.05).The oocyte maturation rate in ICSI was not different among the groups(P>0.05).The normal fertilization rate in group E was significantly lower than group B,C and D(P<0.05).The embryo utilization rate in group F was significantly lower than the other groups(P<0.05).The ICSI-2PN rate,cleavage rate and excellent embryo rate in each group had no significant difference(P>0.05).The clinical pregnancy rate of first transplantation in group B was significantly lower than in group D(P<0.005).The implantation rates in group D and group F were significantly higher than those in group A and group B(P<0.05).The whole embryo freezing rate in group D was significantly higher than group B and C(P<0.005).The live birth rate in group B was significantly lower than group C and D(P<0.05).The live birth rate in group E was significantly lower than group C and D(P<0.05).The average number of embryos transferred and abortion rate among the groups showed no significant difference(P>0.05).Conclusions:According to the actual situation of patients with individual doses of long down-regulation protocol can not only effectively inhibit the early onset of LH peak,but also to achieve the desired level of down-regulation and better pregnancy outcome.