促性腺激素释放激素激动剂联合小剂量HCG双扳机在IVF-ET中的临床应用

Clinical application of GnRH agonist combined with low-dose HCG double trigger in IVF-ET cycles

目的探讨促性腺激素释放激素激动剂(GnRH-a)联合小剂量HCG扳机在IVF-ET温和刺激方案中的临床应用。方法选取2014年1月至2018年6月在我院就诊行IVF-ET温和刺激方案的165例患者,随机分为3组,采用不同的扳机方案:GnRH-a扳机组(60个周期)给予GnRH-a 0.2 mg皮下注射;双扳机组(42个周期)给予GnRH-a 0.2 mg皮下注射和小剂量HCG 2 000 U肌肉注射;HCG扳机组(63个周期)给予HCG 10 000 U肌肉注射。比较3组患者的临床参数,包括Gn天数、Gn用量、扳机日E2和P水平以及14 mm以上的卵泡数和平均获卵数;比较3组患者的实验室参数,包括患者的MⅡ卵率、受精率、卵裂率和优胚率;比较鲜胚和冻胚移植的临床妊娠结局,包括平均移植胚胎数目、胚胎着床率、临床妊娠率、自然流产率以及卵巢过度刺激综合征(OHSS)发生率。结果在温和刺激方案中,无论单用GnRH-a扳机、双扳机还是HCG扳机,3组患者新鲜周期的Gn天数、Gn用量、扳机日E2和P水平、14 mm以上的卵泡数、平均获卵数、受精率和卵裂率均无显著差异(P均>0.05);双扳机组MⅡ卵率和优胚率显著高于GnRH-a扳机组和HCG扳机组[分别为(89.85±15.12)%vs.(83.45±12.74)%vs.(84.16±14.52)%;(49.95±19.65)%vs.(46.02±18.89)%vs.(46.98±22.37)%](P均<0.05);GnRH-a扳机组鲜胚移植自然流产率显著高于双扳机组(15.79%vs. 7.14%,P<0.05),而在冻胚移植周期两组自然流产率无统计学差异(7.1%vs. 9.1%,P>0.05);HCG扳机组OHSS发生率显著高于其他两组(P<0.05);3组患者间鲜胚和冻胚移植周期胚胎着床率、临床妊娠率均无统计学差异(P>0.05)。结论温和刺激方案中,采用双扳机可以得到优质胚胎,获得满意的胚胎种植率和临床妊娠率,且自然流产率不高,中、重度OHSS发生率明显下降,能够取得良好的妊娠结局,有较高的临床应用价值。

Objective:The clinical application of GnRH agonist(GnRH-a)combined with low-dose HCG double trigger in IVF-ET.Methods:A total of 165 patients who underwent IVF-ET in our hospital from January 2014 to June 2018 were selected.The patients were randomly divided into three groups according to the different trigger methods:GnRH-a 0.2 mg subcutaneous injection in GnRH-a trigger group(n=60),GnRH-a 0.2 mg subcutaneous injection and low dose HCG 2000 U i.m.in double trigger group(n=42)and HCG 10000 U i.m.in HCG trigger group(n=63).The clinical parameters including the days&dosage of gonadotropin(Gn)used,the levels of E2 and progesterone on the day of trigger,the number of follicles above 14 mm and the average number of oocytes retrieved were compared among the three groups.The laboratory parameters including MⅡoocytes rate,fertilization rate,cleavage rate and good quality embryo rate were compared among the three groups.The clinical pregnancy outcomes of fresh&frozen embryo transfer,including the average number of embryos transferred,embryo implantation rate,clinical pregnancy rate,spontaneous abortion rate and the incidence of ovarian hyperstimulation syndrome(OHSS)were compared among the three groups.Results:There were no significant differences in the days&dosage of Gn used,E2 and progesterone levels on trigger day,number of follicles over 14 mm,average number of oocytes retrieved,fertilization rate and cleavage rate among the three groups in fresh cycle with mild stimulation protocol,regardless of the GnRH-a trigger,double trigger or HCG trigger alone(P>0.05).The MⅡoocytes rate[(89.85±15.12)%vs.(83.45±12.74)%vs.(84.16±14.52)%]and good quality embryo rate[(49.95±19.65)%vs.(46.02±18.89)%vs.(46.98±22.37)%]in double trigger group were significantly higher than in GnRH-a trigger and HCG trigger group(P<0.05).The spontaneous abortion rate in fresh embryo transfer cycles was significantly higher in GnRH-a trigger group than the double trigger group(15.79%vs.7.14%,P<0.05),however,the spontaneous abortion rate in frozen embryo transfer cycles was no different(7.1%vs.9.1%,P>0.05).The incidence of OHSS in HCG trigger group was significantly higher than that in other two groups(P<0.05).There was no significant difference in embryo implantation rate and clinical pregnancy rate in fresh&frozen embryos transfer cycles among the three groups(P>0.05).Conclusions:In mild stimulation protocol,high quality embryos,satisfactory embryo implantation rate and clinical pregnancy rate can be obtained using double trigger,and the spontaneous abortion rate is not high.The incidence of moderate and severe OHSS is significantly decreased,and a good pregnancy outcome can be achieved.It has a high clinical value.