黄体期长效长方案促性腺激素释放激素激动剂剂量对IVF/ICSI临床结局的影响

Effect of GnRH-a dosage on IVF/ICSI clinical outcomes in luteal phase long protocol

目的探讨不同促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist, GnRH-a)剂量对体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer, IVF/ICSI-ET)临床结局的影响。方法采用前瞻性队列研究, 选择2018年1月至2019年1月期间在广州医科大学附属第三医院生殖医学中心接受IVF/ICSI-ET的患者为研究对象, 最终纳入273例。所有患者采用黄体期长方案促排卵, 根据GnRH-a剂量分为1.0 mg、0.8 mg和0.5 mg三组, 比较患者基础临床特征和控制性超促排卵、胚胎移植及子代数据。结果三组患者基础临床特征及子代数据差异均无统计学意义(均P>0.05)。随降调节剂量的减少, 卵巢刺激时间明显下降, 0.5 mg组最短, 为(11.3±1.4)d, 差异有统计学意义(P<0.001);促性腺激素(gonadotropin, Gn)使用总量有下降趋势, 胚胎丢失率降低, 活产率升高, 但差异均无统计学意义(均P>0.05)。在1.0 mg组, 受精率最低, 为71.6%(768/1073), 三组间差异有统计学意义(P=0.005), 早期流产率、无可用胚胎周期取消率有升高趋势, 但差异均无统计学意义(均P>0.05)。结论 GnRH-a 0.5 mg可减少促排卵时间并取得良好的临床结局, 是更优的降调节剂量。

Objective To investigate the effect of different dosages of gonadotropin-releasing hormone agonist(GnRH-a)on the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET).Methods In this prospective cohort study,we recruited patients who received IVF/ICSI-ET in Center for Reproductive Medicine,the Third Affiliated Hospital of Guangzhou Medical University from January 2018 to January 2019.A total of 273 patients were finally enrolled in the the study.We used the luteal phase long protocol in the controlled ovarian hyperstimulation program.Patients were divided into three groups according to the dosage of GnRH-a used:1.0 mg,0.8 mg and 0.5 mg.The basic clinical characteristics,controlled ovarian hyperstimulation,embryo transfer and offspring data were compared among the three groups.Results There were no significant differences in basal clinical characteristics and offspring data(all P>0.05).The lower dosage of GnRH-a,the fewer days of ovarian stimulation,0.5 mg group showed the least days of ovarian stimulation[(11.3±1.4)d],which was statistically significant from the other groups(P<0.001).In addition,we also found a decreasing trend of total gonadotropin(Gn),a lower loss rate of the embryo and a higher live birth rate in 0.5 mg group,although the difference did not reach statistically significant(all P>0.05).On the contrast,in 1.0 mg group,the fertilization rate[71.6%(768/1073)]significantly decreased(P=0.005),while the early abortion rate and the cancellation rate of the unavailable embryo cycles tended to increase but not statistically different(all P>0.05).Conclusion 0.5 mg GnRH-a can reduce the duration of ovarian stimulation and achieve good clinical outcomes,which may be a better dosage of down regulation.