促性腺激素释放激素激动剂预处理周期对子宫腺肌病患者体外受精/卵胞浆内单精子注射-胚胎移植助孕结局的影响

Effect of Gonadotropin-Releasing Hormone Agonist Pretreatment Cycle on Pregnancy Outcomes of Patients with Adenomyosis Undergoing In Vitro Fertilization/Intracytoplasmic Sperm Injection-Embryo Transfer

目的探讨促性腺激素释放激素激动剂(GnRH-a)治疗周期数对子宫腺肌病患者行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕结局的影响。方法收集于2014年1月至2019年6月在郑州大学第一附属医院生殖医学中心行第1周期IVF/ICSI-ET且子宫体积<12孕周的201例子宫腺肌病患者的临床资料。根据促性腺激素释放激素的治疗周期数将患者分为使用卵泡期长效长方案组(A组,119例)和超长方案组(B组,82例),比较两组临床资料、促排卵治疗数据及logistic回归分析影响临床妊娠的相关因素。结果两组患者促性腺激素(Gn)天数、Gn用量、注射人绒毛膜促性腺激素(HCG)日内膜厚度、HCG日雌激素水平、获卵数、优胚率、种植率、妊娠率、流产率、活产率、早产率比较,差异无统计学意义(P>0.05)。logistic回归分析显示,年龄、窦卵泡数是临床妊娠的影响因素,GnRH-a应用周期数与子宫腺肌病患者妊娠结局无相关性(P>0.05)。结论对于子宫体积<12孕周的子宫腺肌病患者,应用1个周期GnRH-a降调节的卵泡期长效长方案可以达到与应用2个周期GnRH-a降调节的超长方案相同的临床效果,且缩短了患者到达妊娠的时间,减轻了医疗费用。因此,卵泡期长效长方案可以作为子宫腺肌病患者的一种经济有效且安全的治疗方案。

Objective To investigate the effect of the number of cycles of gonadotropin-releasing hormone agonist GnRH-a on the pregnancy outcome of patients with adenomyosis undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET).Methods The clinical data of 201 patients with adenomyosis who underwent the first cycle of IVF/ICSI-ET and uterine volume<12 gestational weeks in the Reproductive Medical Center of the First Affiliated Hospital of Zhengzhou University from January 2014 to June 2019 were collected.According to the number of treatment cycles using gonadotropin-releasing hormone,the patients were divided into the long-term treatment group(group A,119 cases)and the ultra-long treatment group(group B,82 cases).The basic clinical data,ovulation induction treatment data and logistic regression analysis affecting clinical pregnancy were compared between the two groups.Results There were no differences in the number of days of gonadotropin(Gn),dosage of Gn,endometrial thickness on the day of injection of human chorionic gonadotropin(HCG),estrogen level on the day of HCG,number of oocytes retrieved,excellent embryo rate,implantation rate,pregnancy rate,abortion rate,live birth rate and premature delivery rate between the two groups(P>0.05).Logistic regression analysis showed that age and number of antral follicles were the influencing factors of clinical pregnancy,while the number of GnRH-a application cycles was not correlated with the pregnancy outcome of patients with adenomyosis(P>0.05).Conclusion For patients with adenomyosis with uterine volume<12 gestational weeks,the long-acting follicular phase regimen with one cycle GnRH-a down regulation can achieve the same clinical effect as the long-acting follicular phase regimen with two cycles GnRH-a down regulation,shorten the time for patients to reach pregnancy and reduce medical costs.Therefore,long-acting follicular phase regimen can be used as an economical,effective and safe treatment for adenomyosis.