Pregnancy outcomes following supplementation of single dose GnRH agonist to sustain the luteal phase in antagonist fresh embryo transfer cycles:A multicentric prospective cohort study

Objective:To determine whether a single dose of gonadotropin-releasing hormone(GnRH)agonist administered subcutaneously in addition to the regular progesterone supplementation could provide a better luteal support in antagonist protocol fresh embryo transfer cycles.Methods:This prospective,multicentric,cohort study included total 140 women,70 in each group.Controlled ovarian stimulation was carried out as per fixed GnRH antagonist protocol.The trigger was given with hCG.In vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)was performed and day-3 embryos were transferred.Patients were divided into groups 1 and 2 based on computer generated randomization sheet.Six days following oocyte retrieval,group 1 received 0.2 mg decapeptyl subcutaneously in addition to regular progesterone support while group 2 received progesterone only.Luteal support was given for 14 days to both groups;if pregnancy was confirmed luteal support was continued till 12 weeks of gestation.The clinical pregnancy rate was the primary outcome.The implantation rate,miscarriage rate,live birth delivery rate,and multiple pregnancy rates were the secondary outcomes.Results:A total of 140 patients were analysed,70 in each group.Clinical pregnancy rates(47.1%vs.35.7%;P=0.17),implantation rates(23.4%vs.18.1%,P=0.24),live birth delivery rates(41.4%vs.27.1%,P=0.08),and multiple pregnancy rates(21.2%vs.16.0%,P=0.74)were higher in group 1 than in group 2.Group 1 had a lower miscarriage rate than group 2(5.7%vs.8.6%;P=0.75).However,these differences were not statistically significant between the two groups.Conclusions:Administration of a single dose of GnRH agonist in addition to regular natural micronized vaginal progesterone as luteal support in GnRH antagonist protocol cycles marginally improves implantation rates,clinical pregnancy rates,and live birth delivery rates.However,more studies with higher sample sizes are needed before any conclusive statements about GnRH agonist as luteal phase support can be made.

GnRH激动剂在人工周期冻融胚胎移植黄体支持中作用的荟萃分析

目的:评价GnRH激动剂(GnRH-a)在人工周期冻融胚胎移植(AC-FET)黄体期支持(LPS)中的作用。方法:纳入PubMed、EMBASE和Cochrane数据库中符合纳入标准的研究。检索期限为建库至2023年10月31日。观察指标为种植率、HCG阳性率、临床妊娠率、持续妊娠率、活产率、流产率、宫外妊娠率、多胎妊娠率。采用RevMan5.4软件分析。结果:纳入9项随机对照试验(RCT),共2451例患者,其中GnRH-a LPS组1252例,常规LPS组1199例。黄体期给予GnRH-a可提高种植率(OR=1.29,95%CI为1.12~1.49,P=0.0005)、临床妊娠率(OR=1.32,95%CI为1.12~1.57,P=0.001)和多胎妊娠率(OR=1.82,95%CI为1.29~2.58,P=0.0007),同时降低流产率(OR=0.57,95%CI为0.41~0.79,P=0.0008)。两组的HCG阳性率、持续妊娠率、活产率、宫外妊娠率比较,差异均无统计学意义。结论:AC-FET黄体期添加GnRH-a可提高患者的种植率和临床妊娠率,提示GnRH-a可能是AC-FET黄体支持的新选择。然而,需开展多中心、大样本的RCT,以获得GnRH-a有效黄体支持的统一标准,进一步明确其LPS的安全性和有效性。

长效GnRH激动剂与GnRH拮抗剂促排卵方案在反复种植失败患者中的临床应用

目的 比较卵泡期长效促性腺激素释放激素(GnRH)激动剂方案和GnRH拮抗剂方案应用于反复种植失败(RIF)患者的临床效果。方法 回顾性分析2017年6月至2020年3月在中山大学附属第六医院生殖医学中心行体外受精/卵胞浆内单精子注射(IVF/ICSI)治疗的RIF患者的临床资料。根据促排卵方案进行分组,并通过倾向性评分1∶1匹配选择数据,最终纳入594例患者,长效激动剂组(采用长效GnRH激动剂方案促排卵)297例,拮抗剂组(采用GnRH拮抗剂方案促排卵)297例。比较两组患者的一般资料、促排卵及胚胎发育情况、鲜胚移植及冻融胚胎移植妊娠结局。结果 两组患者的年龄、不孕年限、基础激素水平等一般资料比较均无显著性差异(P>0.05)。拮抗剂组HCG日LH水平显著高于长效激动剂组(P<0.05),HCG日子宫内膜厚度、Gn总量、Gn天数、获卵数则显著低于长效激动剂组(P<0.05)。长效激动剂组新鲜周期的临床妊娠率、活产率显著高于拮抗剂组(P<0.05),两组患者冷冻周期的妊娠结局无显著性差异(P>0.05);但长效激动剂组的累计活产率显著高于拮抗剂组(P<0.05)。结论 卵泡期长效激动剂方案促排卵后行新鲜周期移植的助孕策略可以显著改善RIF患者的妊娠结局,值得优先考虑。

A Second Dose of GnRHa in Combination with Luteal GnRH Antagonist May Eliminate Ovarian Hyperstimulation Syndrome in Women with≥30 Follicles Measuring≥11 mm in Diameter on Trigger Day and/or Pre-trigger Peak Estradiol Exceeding 10 000 pg/mL

This observational study included 21 patients at remarkably high risk of ovarian hyperstimulation syndrome(OHSS),characterized by more than 30 follicles measuring≥11 mm in diameter on trigger day and/or pre-trigger peak estradiol exceeding 10 000 pg/mL.which was also the feature of women with established severe early OHSS followed by gonadotrophin-releasing hormone agonist(GnRHa)trigger and freeze-all policy that previously have been reported.All patients received a second dose of GnRHa 12 h after the first GnRHa trigger combined with administration of GnRH antagonist at 0.25 mg/day for a period of 3 days from the day of oocyte retrieval onwards.The in vitro fertilization(IVF)outcomes may be preferable compared with a bolus of GnRHa trigger and none of the included patients developed moderate-to-severe OHSS.Moreover,patients'symptoms,reproductive honnone levels and ultrasound findings were improved significantly.This new strategy seems to be efficacious and could be a further supplement of GnRHa trigger with or without applying freeze-all strategy to completely prevent early-onset moderate to severe OHSS,especially for the patients characterized by≥30 follicles measuring≥11 mm in diameter on trigger day and/or pre-trigger peak estradiol exceeding 10 000 pg/mL.Further studies should be performed to compare this regimen with conventional methods of OHSS prevention.

Comparison between a GnRH Agonist and a GnRH Antagonist Protocol for the Same Patient Undergoing IVF

In order to compare GnRH agonist with antagonist protocol for the same patient during controlled ovarian stimulation cycles, the in vitro fertilization and embryo transfer （IVF-ET） outcome was retrospectively studied in 81 patients undergoing 105 agonist protocols and 88 antagonist protocols. The results showed that there was no statistically significant difference in duration of ovarian stimulation, number of ampoules, oocytes retrieved, serum estradiol （E2） and progesterone （P） levels, thickness of endometrium, the zygote- and blastocyst-development rate between GnRH agonist and antagonist protocols （P〉0.05）. High quality embryo rate was higher in antagonist protocols, but there was no significant difference between two protocols. Implantation rate and clinical pregnant rate were significantly higher in antagonist protocol （15.82% and 30.26%, respectively） than in agonist protocol （5.26% and 10.64% respectively （P〈0.05）. It was concluded GnRH antagonist protocol probably improved the outcome of pregnancy of older patients with a history of multiple failure of IVF-ET in a GnRH protocol.

GnRH-Agonist Trigger versus Human Chorionic Gonadotrophin (HCG) Trigger in Cases of Controlled Ovarian Stimulation;Randomized Controlled Trial

Objectives: The aim of the study was to compare the efficacy and safety of GnRH-agonist to the human chorionic gonadotrophin (HCG) trigger in cases of simple ovarian stimulation. Study design: Randomized controlled trial was conducted on 291 women complaining of unexplained infertility visiting Elshatby Maternity University Hospital from February to December 2019. Trial registration unique ID is PACTR202001787868341 (https://www.pactr.org/). Age included from 20 - 43 years. All patients were stimulated by the sequential stimulation protocol using letrozole then FSH injection, when the criteria of ovulation trigger were reached; cases were randomized into two groups using closed envelopes method. Group A (123 cases) GnRh agonist (triptorelin 0.2 IU) subcutaneous injection and Group B (168 cases) HCG 10,000 IU intramuscular injection were used for triggering of ovulation then followed by timed intercourse. Results: Primary outcome was the clinical pregnancy rate while rate of miscarriage and ovarian hyper-stimulation rate were the secondary outcome. Clinical pregnancy rates, in Group A were (21.1%) while it was (31.5%) in another group (P = 0.049). Miscarriage rate was (4.9%) in the first group and (3.6%) in the second group (P = 0.580). Except for one case of moderate ovarian hyper-stimulation syndrome (OHSS) complicated the HCG group, there were no such cases in GnRH group. Conclusion: Triggering final oocyte maturation with HCG was superior to GnRH agonists triggers as regards the clinical pregnancy rate.

GnRH Antagonist Protocol: Is It Effective for Expected Poor Ovarian Responders with Tubal Factor Undergoing IVF?

Background: This study aimed to determine if the gonadotropin releasing hormone (GnRH) antagonist protocol is optimal for expected poor ovarian responders with tubal factor undergoing in vitro fertilization-embryo transfer (IVF-ET). Methods: A total of 341 IVF-ET cycles were retrospectively identified. The following inclusion criteria were applied: age ≥ 40 years and patients with tubal factors. The cycles were divided into two groups: a GnRH antagonist group (157 cycles) and a GnRH agonist group (184 cycles). Results: The duration of stimulation and the total doses of gonadotropin in the GnRH agonist group were significantly more than those in the GnRH antagonist group (P < 0.05). There were significant differences in LH and P values on the hCG measurement days between the two groups (0.91 ± 1.17 vs. 4.82 ± 4.69 U/L and 0.69 ± 0.42 vs. 1.03 ± 0.50 ng/mL, P < 0.05). The implantation rate of the GnRH antagonist group was 12.24%, which was slightly higher than that of the GnRH agonist group (10.10%, P = 0.437). The clinical pregnancy rate of the two groups showed no statistical differences (23.36% vs. 23.03%, P = 1.000). Conclusion: For expected poor ovarian responders, the GnRH antagonist protocol was, to some extent, superior to the GnRH agonist protocol in terms of the implantation and clinical pregnancy rates.

GnRH Antagonist Protocol: Is It Optimal for All Patients of Different Ages Undergoing <i>In Vitro</i>Fertilization and Embryo Transfer?

Background: To assess the effect of these two protocols in patients of different ages. Methods: 1923 in vitro fertilization and embryo transfer (IVF-ET) cycles were divided into two groups: a GnRH-ant protocol group and GnRH-a long protocol group, and then every group were subdivided into four age ranges. The general materials and IVF outcomes were compared. Results: The incidence of OHSS fluctuated from 0% to 2.37% with GnRH-ant protocol, which was significantly lower than another (P P Conclusion: The antagonist protocol should be considered in patients with a high ovarian response (e.g., PCOS patients) to avoid OHSS. Older patients (>35 years) could be treated with the antagonist protocol.

卵巢储备功能正常人群卵泡期GnRH-a长方案不同时期添加尿促性腺激素对临床结局的影响

目的探讨卵巢储备功能正常患者在卵泡期GnRH激动剂(GnRH-a)长方案中不同时机添加高纯度尿促性腺激素(Hp-HMG)对临床结局的影响。方法回顾性分析2019年4月至2021年12月在我院生殖中心行IVF/ICSI-ET助孕的462例卵巢储备功能正常患者的484个周期临床资料,均采用卵泡期GnRH-a长方案促排卵。根据方案中添加Hp-HMG(外源性LH类似物,含FSH、LH各75 U/支)时机不同分为两组:早卵泡期开始全程添加Hp-HMG为早加组(n=332);晚卵泡期即控制性卵巢刺激(COS)的第6~8天添加Hp-HMG为晚加组(n=152)。比较两组患者的一般资料、促排卵结局及临床妊娠结局。结果(1)两组间年龄、不孕年限、基础FSH、LH、PRL、孕酮、雄激素水平、抗苗勒管激素(AMH)水平和基础窦卵泡数(AFC)比较均无显著差异(P>0.05);早加组血清基础雌二醇(E 2)水平显著低于晚加组(P<0.05),体质量指数(BMI)显著高于晚加组(P<0.05)。(2)GnRH-a降调节后,两组间促性腺激素(Gn)启动日血清FSH、LH及E 2水平,HCG日血清LH、E 2水平和内膜厚度比较均无显著差异(P>0.05);早加组Gn起始剂量略高于晚加组但无统计学差异(P>0.05),早加组Gn天数、Gn总量显著高于晚加组(P<0.05),而HCG日孕酮水平显著低于晚加组(P<0.05)。(3)两组间平均获卵数、MⅡ卵数、2PN数、D3可利用胚胎数、优胚率、胚胎着床率、临床妊娠率比较均无显著差异(P>0.05)。(4)多重线性回归分析显示,Hp-HMG添加时机与血清孕酮水平显著相关(P<0.05)。结论卵巢储备功能正常患者在卵泡期GnRH-a长方案不同时机补充Hp-HMG不影响临床结局,但早卵泡期添加Hp-HMG有利于HCG日孕酮保持较低水平。

GnRH-a联合LNG-IUS治疗子宫腺肌病相关经量过多的随访结局评价

目的:评价促性腺激素释放激素激动剂(GnRH-a)联合左炔诺孕酮宫内缓释系统(LNG-IUS)治疗子宫腺肌病相关经量过多的随访结局。方法:选取西南医科大学附属医院2018年6月至2020年6月接诊的子宫腺肌病相关经量过多患者作为研究对象。研究对象均给予GnRH-a联合LNG-IUS治疗。分析治疗前、治疗后6、12、24、36和48个月的经量图形失血(PBAC)评分、痛经程度视觉模拟(VAS)评分、子宫体积、CA125水平、贫血情况、LNG-IUS带器率。结果:纳入研究患者187例,中位随访时间36.7个月,治疗后48个月累积带器率90.4%,经量过多症状缓解率89.9%。治疗后48个月内,患者的PBAC评分、VAS评分、子宫体积和CA125水平在每个随访时间点与治疗前比较均有显著改善(P<0.01)。结论:GnRH-a联合LNG-IUS可改善子宫腺肌病相关经量过多患者的持续带器率和随访结局。

腹腔镜手术联合GnRH激动剂治疗重度子宫内膜异位症120例临床分析

目的观察腹腔镜手术联合GnRH激动剂治疗重度子宫内膜异位症的疗效。方法 2004年7月～2008年7月我院对120例重度子宫内膜异位症采用腹腔镜手术治疗宫内膜异位病灶,术后给予达菲林或诺雷德治疗6个月。结果 120例均行腹腔镜卵巢囊肿剥除术+盆腔粘连松解术+盆腔子宫内膜异位病灶电灼术,其中3例行宫骶韧带切断术,6例行双侧圆韧带悬吊术。120例随访6～60个月,平均26个月,复发率8.3%(10/120),73例合并不孕治疗后1年自然妊娠率42.5%(31/73)。结论腹腔镜手术联合GnRH激动剂治疗重度子宫内膜异位症临床效果满意。

GnRH拮抗剂方案与GnRH激动剂长方案在PCOS患者行IVF-ET的比较

目的比较不同促排卵方案在多囊卵巢综合征(PCOS)患者行体外受精-胚胎移植(IVF-ET)中的应用效果。方法 104例PCOS患者随机分为两组:促性腺激素释放激素(GnRH)拮抗剂组41例和GnRH激动剂长方案(对照组)63例,统计比较两组促性腺激素(Gn)的用量及用药天数、人绒毛膜促性腺激素(HCG)日的雌二醇(E2)、黄体生成素(LH)水平、获卵数、受精率、卵裂率、优胚率、种植率、临床妊娠率、周期取消率和卵巢过度刺激综合征(OHSS)的发生率。结果两组的获卵数、受精率、卵裂率、优胚率、临床妊娠率、种植率比较均无明显差异(P>0.05);GnRH拮抗剂组的Gn使用量及天数均少于对照组(P<0.05);GnRH拮抗剂组HCG日的E2水平低于对照组(P<0.05);GnRH拮抗剂组HCG日LH水平高于对照组(P<0.05);GnRH拮抗剂组的周期取消率4.88%低于对照组的25.40%(P<0.05),GnRH拮抗剂组的OHSS发生率2.44%低于对照组的12.70%(P>0.05)。结论 GnRH拮抗剂方案较GnRH激动剂长方案能减少周期取消率、降低OHSS发生风险,而获卵数、受精率、卵裂率、优胚率、临床妊娠率、种植率方面不受影响;GnRH拮抗剂方案能缩短治疗时间、减少治疗费用,具有较好的安全性和有效性,对PCOS患者行IVF-ET是一种比较理想的选择。

低剂量GnRH激动剂长方案和GnRH拮抗剂方案在卵巢储备功能低下患者中的应用比较

目的比较低剂量的GnRH激动剂(GnRH-a)长方案和GnRH拮抗剂(GnRH-ant)方案在卵巢储备功能低下(DOR)患者中的应用效果,以期为此类患者选择更合适的促排卵方案提供参考。方法根据纳入标准和排除标准,收集2018年1月至2019年6月在本院辅助生殖中心进行IVF/ICSI治疗的患者资料进行回顾性分析。按照促排卵方案的不同分为GnRH-ant方案(GnRH-ant组,91个周期)和低剂量GnRH-a长方案(GnRH-a组,147个周期),比较两组的胚胎发育情况和临床妊娠情况;各组再根据年龄分为两个亚组,分别是GnRH-ant年轻组(≤35岁)、GnRH-ant年长组(>35岁)、GnRH-a年轻组(≤35岁)和GnRH-a年长组(>35岁),进行比较分析。结果(1)不同促排卵方案分组比较:两组患者一般情况比较无统计学差异(P>0.05),GnRH-ant组的Gn用量和促排时间均显著低于GnRH-a组(P<0.05),两组间获卵数、受精率、优胚率和囊胚形成率、种植率、临床妊娠率、流产率及活产率均无统计学差异(P>0.05),但GnRH-ant组囊胚形成率略高(33.0%vs 25.2%,P>0.05)。(2)不同方案内年龄亚组比较:GnRH-ant年轻组获卵数显著高于年长组(P<0.05),年轻组受精率、临床妊娠率和活产率略高于年长组,但均无统计学差异(P均>0.05);GnRH-a年轻组获卵数显著高于年长组(P<0.05),年轻组受精率、囊胚形成率种植率和活产率略高于年长组,但均无统计学差异(P均>0.05),但年轻组临床妊娠率显著高于年长组(57.1%vs.30.8%,P<0.05)。(3)跨方案同年龄组比较:GnRH-ant年轻组囊胚形成率略高于GnRH-a年轻组,而种植率、临床妊娠率和活产率均略低于GnRH-a年轻组,但均无统计学差异(P均>0.05);GnRH-ant年长组受精率显著低于GnRH-a年长组(P<0.05),而囊胚形成率和临床妊娠率均略高于GnRH-a年长组,但均无统计学差异(P均>0.05)。结论对于DOR患者,应用GnRH-ant能够达到与低剂量GnRH-a相似的临床结局,且拮抗剂方案的Gn量和Gn天数更少。

GnRH拮抗剂方案及GnRH-a短方案用于卵巢低反应患者助孕临床疗效Meta分析

目的比较卵巢低反应(POR)患者行促性腺激素释放激素拮抗剂(GnRH-ant)及GnRH激动剂(GnRH-a)短方案的临床疗效。方法计算机检索PubMed、ProQuest Medical Library、Medline外文生物医学期刊文献数据库、中国生物医学文献数据库(CBM)、中国知网(CNKI)、中国科技期刊数据库(VIP)、万方数据库和读秀学术搜索引擎等。收集2000年至2014年10月发表的相关文献,比较POR患者行GnRH-ant及GnRH-a短方案的临床试验,按Cochrane系统评价方法提取有效数据,采用RevMan 5.2软件进行Meta分析。结果共纳入11篇文献,共855例(1 054个周期)POR患者,其中GnRHant组444例(549个周期),GnRH-a短方案组411例(505个周期);Meta分析结果显示:对于POR患者,两组间临床妊娠率[RR=1.25,95%CI(0.96,1.63),P=0.10]、促性腺激素(Gn)时间[WMD=-1.15,95%CI(-2.56,0.25),P=0.11]、Gn用量[WMD=63.54,95%CI(-59.08,186.17),P=0.31]、获卵数[WMD=0.16,95%CI(-0.66,0.98),P=0.70]、周期取消率[RR=1.07,95%CI(0.85,1.35),P=0.57]差异均无统计学意义,但临床妊娠率的结果偏向于拮抗剂组更优。结论对于POR患者,拮抗剂方案和GnRH-a短方案效果无统计学差异,但是拮抗剂组可能更有助于提高临床妊娠率,可以作为POR患者助孕的一个选择。

长效/短效GnRH激动剂长方案分别用于卵泡期/黄体期的临床效果比较

目的比较卵泡期长效促性腺激素释放激素激动剂（GnRH-a）长方案和黄体期短效GnRH-a长方案在体外受精-胚胎移植中的治疗结局。方法回顾性分析2015年5月~2016年2月在本院行体外受精-胚胎移植的患者5 197例,其中A组：卵泡期长效GnRH-a长方案2 395例,B组：短效GnRH-a长方案2 802例,比较两种方案的临床特征及结局。结果两组间bFSH[（7.01±2.33vs.7.20±2.34）U/L]、周期数（1.31±0.43vs.1.12±0.41）、rFSH总量[（1 672.55±521.84）vs.（1 829.33±741.08）U]、HMG总量[（938.59±909.14）vs.（207.38±364.85）U]、促性腺激素（Gn）天数[（13.89±2.48）vs.（11.64±1.84）d]、HCG日E2[（13 033±7 909）vs.（18 267±10 277）pmol/L]、P[（3.14±1.87）vs.（2.82±1.49）nmol/L]、LH[（1.05±1.51）vs.（1.55±0.85）U/L]、内膜厚度[（12.11±2.49）vs.（11.75±2.38）mm]、≥16mm卵泡数[（5.77±2.53）vs.（7.01±3.21）个],14-16mm卵泡数[（2.92±2.26vs.2.75±2.21）个]、12-13mm卵泡数[（2.92±2.29）vs.（2.1±1.91）个]、MⅡ卵泡数[（10.36±6.24）vs.（10.88±6.54）个]、2PN受精率（64.21%vs.67.22%）、优质胚胎率（67.66%vs.74.05%）、着床率（45.34%vs.37.68%）、临床妊娠率（63.72%vs.52.67%）、流产率（8.41%vs.11.55%）、宫外孕率（1.52%vs.3.30%）差异具有统计学意义（P〈0.05）,BMI、全胚冷冻率、取消率、获卵数、平均移植胚胎数、多胎率无显著性差异（P〉0.05）;按年龄分层分析后,各年龄组中A组着床率（年龄〈35岁组：49.98%vs.42.94%;年龄35-40岁组：38.57%vs.27.85%）;及妊娠率（年龄〈35岁组：70.00%vs.59.38%;年龄35~40岁组：57.14%vs.42.24%）;均显著高于B组（P〈0.05）。结论与黄体期短效长方案相比,卵泡期长效GnRH-a长方案能显著提高着床率及临床妊娠率。

GnRH激动剂长方案与GnRH拮抗剂方案在不同年龄组、不同反应人群中的新鲜周期临床结局比较

【目的】比较促性腺激素释放激素激动剂(GnRH-a)长方案和促性腺激素释放激素拮抗剂(GnRH-ant)方案在不同年龄组和不同反应人群中行体外受精或单精子卵胞浆内注射-胚胎移植(IVF/ICSI-ET)新鲜周期移植的临床结局。【方法】回顾性分析中山大学附属第三医院生殖医学中心2015年8月28日至2016年12月31日行IVF/ICSI的737个周期,其中Gn RH-a长方案(A组)386个周期,GnRH-ant方案(B组)351个周期。按年龄和获卵数分成a和b两个亚组:a1组(<38岁),a2组(≥38岁);b1组(获卵数≤5个),b2组(获卵数6~15个),b3组(获卵数>15个)。比较患者的临床资料和助孕结局。【结果】(1)A、B两组的受精率、正常受精率、生化妊娠率、流产率均无统计学差异,A组的促性腺激素(Gn)使用天数、Gn总量、人绒毛膜促性腺激素(hCG)日雌二醇(E2)浓度、h CG日内膜厚度、获卵数、成熟卵子数、卵巢过度刺激综合征(OHSS)发生率、胚胎种植率、临床妊娠率均高于B组(P<0.05),B组的新鲜周期移植取消率高于A组(P<0.001)。(2)按年龄分层后,<38岁亚组使用Gn RH-ant方案的胚胎种植率略低于Gn RH-a长方案(32.6%vs 39.8%,P=0.067),两种方案的临床妊娠率没有统计学差异(54.8%vs 50.4%,P=0.429);≥38岁亚组使用Gn RH-ant方案的胚胎种植率低于Gn RH-a长方案(9.7%vs17.9%,P=0.066),使用Gn RH-ant方案的临床妊娠率低于Gn RH-a长方案(19.6%vs 39.1%),差异有统计学意义(P=0.021)。(3)按获卵数分层后,除b1亚组Gn RH-ant方案的胚胎种植率低于Gn RH-a长方案以外(13.1%vs 26.0%,P=0.026),b2、b3亚组使用两种方案的胚胎种植率没有统计学差异;b1、b2、b3三个亚组使用两种方案的临床妊娠率均没有统计学差异,但是b1亚组两种方案的临床妊娠率相差较大(36.6%vs 19.3%,P=0.056)。【结论】总体而言,Gn RH-a长方案的胚胎种植率和临床妊娠率高于Gn RH-ant方案,但Gn RH-ant方案可降低Gn的用量,缩短治疗时间,并有效减少OHSS的发生。对于年轻的卵巢正常反应患者甚至是高反应患者,两种方案有相似的临床结局;而对于高龄等低反应患者,则使用Gn RH-a长方案的胚胎种植率和临床妊娠率更高。

GnRH激动剂长方案和GnRH拮抗剂方案对IVF-ET结局的影响:一项前瞻性随机对照研究

控制性超排卵（COH）是体外受精一胚胎移植（IVF_ET）技术的重要组成部分，1984年Porter和Craft首先将人工合成的促性腺激素释放激素激动剂（gonadotropinreleasinghormoneagonist，GnRH—a）用在IVF中的促排卵治疗[1]，有效地扼制了早发黄体生成素（LH）峰，降低了周期取消率，保证了IVF-ETl的成功率。

在IVF-ET中低剂量长效GnRH-a与短效GnRH-a长方案降调节的评价

目的回顾性分析低剂量长效GnRH-a与短效GnRH-a长方案对IVF-ET周期参数的影响,探讨该方案的安全性和有效性。方法回顾性分析2011年7月至12月在本院生殖医学中心进行IVF-ET治疗的1 928个周期资料,其中长效低剂量(0.375mg,0.8mg和1.0mg 3组)长方案1 093个周期,短效长方案835个。结果 (1)0.375mg组HCG日血清LH水平显著高于其它3组(P<0.05)。(2)HCG日血清E2水平在4组之间无差异;短效组血清孕酮(P)水平[(1.9±0.95)nmol/L]显著低于长效0.375mg,0.8mg和1.0mg 3组[(2.2±1.3)、(2.5±1.6)、(2.2±1.6)nmol/L](P<0.005)。(3)短效组和长效0.375mg组FSH启动剂量显著高于长效0.8mg和1.0mg两组(P<0.005);短效组FSH总量、HMG总量与Gn使用时间和平均获卵数均显著低于长效3组(P<0.005);(4)卵巢高反应发生率在0.8 mg(31.0%)和1.0 mg(31.9%)组显著高于0.375mg(18.2%)和短效组(15.7%);1.0mg组卵巢低反应率和取消移植率均显著低于其它3组(P<0.05)。(5)IVF-ET参数:1.0mg组获卵数、MⅡ卵母细胞数、受精数、可用胚胎数均显著高于其余3组,但MⅡ卵母细胞率、正常受精率无差异;0.8mg组卵母细胞利用率显著高于其它3组;1.0mg和0.8mg组临床妊娠率显著高于短效组和长效0.375mg组;长效1.0mg组种植率(35.4%)显著高于其它3组(27.6%、27.3%、28.1%)。结论血清LH水平与GnRHa剂型和剂量有关,短效GnRH-a组与0.375mg长效GnRH-a组呈现出相似的垂体不完全抑制作用,在卵巢水平对E2合成没有显著差别。低剂量长效GnRH-a降调节对IVF-ET结局的影响和机制还有待于前瞻随机对照研究进一步阐明。

GnRH激动剂长效剂型的两种促排卵方案在PCOS患者中的应用

目的比较GnRH激动剂(GnRH-a)长效剂型的两种促排卵方案在PCOS患者中的治疗结局。方法回顾性分析2015年1月至2016年6月在我院行IVF/ICSI-ET治疗的PCOS患者,根据使用长效GnRH激动剂方法的不同分为两组:改良超长方案组(A组,周期数223),减量长效长方案组(B组,周期数200),比较两组患者的一般资料、促排卵情况及种植率、临床妊娠率、早期流产率、抱婴率、中重度OHSS发生率等临床结局差异。结果两组患者的一般情况、基础激素水平和促排卵药物Gn量、HCG日LH、E_2、获卵数均无统计学差异(P>0.05);A组的种植率(50.64%vs.40.91%)、临床妊娠率(67.28%vs.55.48%)、抱婴率(60.49%vs.45.89%)均显著高于B组(P<0.05),而早期流产率(5.50%vs.9.88%)显著低于B组,差异均有统计学意义(P<0.05);A组的OHSS中重度发生率(2.24%vs.2.0%)、2PN受精率(58.23%vs.57.31%)、卵裂率(95.85%vs.95.01)、优胚率(38.23%vs.37.15%)均略高于B组,但差异无统计学意义(P>0.05)。结论与GnRH-a减量长效长方案相比,在PCOS患者中GnRH-a改良超长方案可显著改善妊娠结局,且未增加中重度OHSS发生率,可以为PCOS的治疗提供选择。

拮抗剂方案用于前次IVF/ICSI-ET失败卵巢储备功能减退患者的自身对照研究

目的探讨拮抗剂方案用于前一周期激动剂方案促排卵助孕失败的卵巢储备功能减退(DOR)不孕症患者的临床结局。方法回顾性分析2019年1月至2023年6月在我院生殖医学中心接受IVF/ICSI-ET治疗的69例DOR患者的临床资料,第一周期使用激动剂方案(包括黄体期长方案或卵泡期长方案)促排卵助孕失败,第二周期改用拮抗剂方案促排卵。采用自身对照的研究方法比较前后两个周期的助孕结局。结果前后两个周期间的Gn天数、Gn总量、扳机日E 2及P水平、扳机日子宫内膜厚度、扳机日直径≥14 mm卵泡数比较均无显著性差异(P>0.05)。第二周期的扳机日LH水平显著高于第一周期[(2.42±1.83)U/L vs.(1.77±1.40)U/L,P<0.05];第二周期的获卵数[(6.80±3.56)枚vs.(5.45±3.83)枚]、MⅡ卵数[(5.59±3.15)枚vs.(3.91±3.48)枚]、受精率(76.03%vs.61.87%)、2PN率(67.97%vs.53.07%)、D3优质胚胎数[(2.61±2.40)枚vs.(1.25±1.57)枚]及囊胚形成率(44.44%vs.33.56%)均显著高于第一周期(P<0.05);前后两周期的2PN卵裂率、优质囊胚形成率比较无显著性差异(P>0.05)。前后两周期的周期取消率和鲜胚移植异位妊娠率比较无显著性差异(P>0.05);第二周期鲜胚移植的HCG阳性率(45.65%vs.18.18%)和临床妊娠率(36.96%vs.12.73%)显著高于第一周期(P<0.05),流产率显著低于第一周期(11.76%vs.85.71%,P<0.05)。结论对于第一周期使用激动剂方案促排卵助孕失败的DOR患者,第二周期采用拮抗剂方案促排卵可以提高获卵数和优质胚胎数,有利于改善患者的临床结局。