GnRH激动剂长方案中不同促排卵药物对卵巢慢反应分娩结局的影响

Effects of Different Ovulatory Drugs on Clinical Outcomes in the Long GnRH agonist Protocol with Suboptimal Ovarian Response

[目的]探讨促性腺激素释放激素激动剂(GnRH-a)方案中,卵巢储备正常患者发生卵巢慢反应后,添加含黄体生成素(LH)活性的不同药物对体外受精或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]纳入卵巢储备功能正常、采用GnRH激动剂方案促排卵并发生卵巢慢反应的不孕患者,共872例。按照添加不同药物分为小剂量人绒毛膜促性腺激素(hCG)组、人重组黄体生成素(rLH)组及人绝经期促性腺激素(H MG)组,回顾性分析3组的实验室参数和临床结局。[结果]hCG组采用超长方案促排卵比例高于HMG组(14.3%vs.1.1%,P<0.001);hCG组Gn使用天数及使用总量较HMG组增加[15.0(13.0~16.8)vs.13.0(12.0~15.0)d,P=0.027;2925(2531~3900)vs.2550(2100~3225)U,P=0.046];rLH组的Gn使用天数及使用总量较HMG组减少[13.0(12.0~14.0)vs.13.0(12.0~15.0)d,P=0.009;2400(1950~3075)vs.2550(2100~3225)U,P=0.009]。hCG组中包括了添加HMG或rLH效果不明显者15例,占hCG组53.6%。hCG组、rLH组及HMG组的临床妊娠率(69.2%,58.6%vs.63.8%,P>0.05)和活产率(65.4%,49.6%vs.53.1%,P>0.05)均相当。[结论]卵巢储备功能正常者在GnRH激动剂方案中发生卵巢慢反应时,添加含LH活性的不同药物均可改善卵巢反应,获得相当的妊娠及分娩结局,小剂量hCG在添加HMG或LH后效果不明显者仍可获得相当的效果。

【Objective】To investigate the effect of adding different preparations containing luteinizing hormone activity in patients with normal ovarian reserve but suboptimal response during GnRH agonist protocol when undergoing IVF/ICSIET.【Methods】872 infertile patients with normal ovarian reserve but suboptimal response to FSH during GnRH agonist protocol were enrolled.According to the supplementation of different preparations containing LH activity,patients were divided into three groups,including low-dose hCG group(n=28),rLH group(n=319)and HMG group(n=525).The clinical parameters and pregnancy outcomes were retrospectively compared among three groups.【Results】The proportion of ultra-long GnRH-a protocol in hCG group was higher than that in HMG group(14.3%vs.1.1%,P<0.001).The total duration and dosage gonadotrophin in hCG group were more than that in HMG group[15.0(13.0~16.8)vs.13.0(12.0~15.0)days,P=0.027;2925(2531~3900)vs.2550(2100~3225)U,P=0.046].The total duration and dosage gonadotrophin in rLH group were less than that in HMG group[13.0(12.0~14.0)vs.13.0(12.0~15.0)days,P=0.009;2400(1950~3075)vs.2550(2100~3225)U,P=0.009].There were 53.6%(15/28)patients who still showed suboptimal response after the administration of HMG or rLH in hCG group.The clinical pregnancy rate(69.2%,58.6%vs.63.8%;P>0.05)and live birth rate(65.4%,49.6%vs.53.1%;P>0.05)were similar among these groups.【Conclusions】For patients with normal ovarian reserve but suboptimal response duringGnRH agonist protocol,the supplementation of different preparations containing LH activity showed comparable effect on pregnancy outcomes.The addition of low-dose hCG was effective even when patients still showed suboptimal response after the administration of HMG or rLH.