不孕患者不同时期应用GnRH拮抗剂方案与GnRH激动剂长方案疗效的比较

Comparison of curative effects between GnRH antagonist and GnRH agonist in infertile patients at different periods

目的:探讨促性腺激素释放激素拮抗剂(GnRH-ant)方案和GnRH激动剂(GnRH-a)长方案在同一不孕患者中新鲜胚胎移植的妊娠结局,为促排卵方案的选择提供依据。方法:采用回顾性研究方法,收集2年内接受GnRH-ant方案和GnRH-a长方案促排卵助孕治疗的74例不孕患者(共148个周期)的临床资料和实验室检查资料,分析2种促排卵方案的促排卵效果、胚胎发育情况和新鲜周期移植的临床结局。结果:促排卵情况,与GnRH-a组比较,GnRH-ant组患者促性腺激素(Gn)总用量、使用天数和内膜厚度均降低(P<0.05或P<0.01);血清中人绒毛膜促性腺激素(HCG)日黄体生成素(LH)水平明显升高(P<0.01);获卵数和HCG日血清中孕酮(P)及雌二醇(E2)水平差异无统计学意义(P>0.05)。胚胎情况,与GnRH-a组比较,GnRH-ant组患者2个原核(2PN)率、异常受精率、2PN卵裂率、可用囊胚形成率和优质囊胚形成率均升高,但差异无统计学意义(P>0.05);GnRH-ant组患者优胚率和可利用胚胎率明显升高(P<0.05)。临床妊娠结局,2组患者移植胚胎数目、异位妊娠率、流产率、种植率和临床妊娠率比较差异均无统计学意义(P>0.05)。结论:GnRH-ant方案周期优胚率和可利用胚胎率高于GnRH-a长方案,Gn使用剂量更低且使用时间更短,可能是更适宜的促排卵方案。

Objective:To investigate the pregnancy outcomes of fresh embryo transfer in the same infertile patients receiving the GnRH antagonist(GnRH-ant)program and the GnRH agonist(GnRH-a)program for ovulation, and to provide basis for the selection of ovulation induction program.Methods :Using retrospectively research method,the clinical data and laboratory examination data of74 patients(148 cycles in total)received GnRH-a program and GnRH-ant program treatment for ovulation within 2 years were collected. The effects of ovulation promotion,embryo development and clinical outcome of fresh cycle transplantation were analyzed. Results:The ovulation induction detection results showed that compared with GnRH-a group,the total dose and time of gonadotropin(Gn) use,and endometrial thickness of the patients in GnRH-ant group were decreased(P<0. 05 or P<0. 01);the level of luteinizing hormone(LH)on the human chorionic gonadotropin(HCG)day was significantly increased(P<0. 01);there were no significant differences in the number of oocytes retrieved and the levels of progesterone(P) and estradiol(E2) on the HCG day(P>0. 05). The embryo status detection results showed that compared with GnRH-a group,the 2 pronucleus(2PN)rate,abnormal fertilization rate,2PN cleavage rate,available blastocyst formation rate and high quality blastocyst formation rate in GnRH-ant group were increased,but there were no significant differences(P>0. 05),while the good embryo rate and available embryo rate in GnRH-ant group were significantly increased(P<0. 05). In clinical pregnancy outcome,there were no significant differences in the number of embryos transferred,ectopic pregnancy rate, abortion rate, implantation rate and clinical pregnancy rate in two groups(P>0. 05).Conclusion:GnRH-ant program could be a more suitable plan for ovulation due to the higher good embryo rate,avaliable embryo rate,lower Gn dose and shorter Gn using time compared with GnRH-a program.