| 不同剂型、剂量促性腺激素释放激素激动剂用于长方案降调节的效果比较 |
| 投稿时间：2017-04-08 修订日期：2017-05-27 点此下载全文 |
| 引用本文：代愉恒,陆秀娥.不同剂型、剂量促性腺激素释放激素激动剂用于长方案降调节的效果比较[J].医学研究杂志,2017,46(12):132-136 |
| DOI：
10.11969/j.issn.1673-548X.2017.12.033 |
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| 中文摘要:目的 笔者单位探索使用不同剂量长效GnRH-a用于长方案促排卵治疗，与常规使用每日注射短效GnRH-a长方案的IVF-ET患者进行相互对照比较其临床疗效，以期寻求最优剂量的GnRH-a降调节。方法 回顾性分析214例在笔者医院接受体外受精-胚胎移植辅助生育的患者，根据患者使用GnRH-a的不同剂量、剂型分为4组，A组：106例于黄体中期开始每日注射0.1mg GnRH-a至HCG日。B组：18例于黄体中期一次性注射长效GnRH-a 3.75mg。C组：35例于黄体中期一次性注射长效GnRH-a 2.0mg。D组：55例于黄体中期一次性注射长效GnRH-a 0.9mg，降调节后予以Gn促排卵。经阴道B超监测当双侧卵巢内至少2个卵泡直径16~20mm时，停用促性腺激素并测定血清E2、P、LH水平。当晚使用人绒毛膜促性腺激素注射，36h后经阴道超声引导下行穿刺取卵术，采用常规IVF受精。结果 4组在降调节时的LH水平、获卵数、受精数、优质胚胎数、临床妊娠率比较，差异无统计学意义。在Gn使用量上：A组与D组差异无统计学意义，B组和C组比较，差异无统计学意义，A、D组较B、C组使用量少。在促排卵时间上：A组与C组比较，差异有统计学意义（P<0.005），A组较C组使用时间长，其余各组间比较，差异无统计学意义；在受精率上B组较其余各组受精率低，差异有统计学意义（P<0.005），其余各组间受精率比较，差异无统计学意义（P>0.05）。结论 长效长方案与短效长方案均能达到垂体降调的效果，且在临床妊娠率上比较，差异无统计学意义（P>0.05）。然而，使用0.9mg GnRH-a组较其余各组有显著优势，与其他长效组比较可以减少Gn注射剂量，减轻患者经济压力；与短效组比较，可以减少注射次数，值得推广。 |
| 中文关键词:促性腺激素激动剂 体外受精-胚胎移植 垂体降调节 控制性超促排卵长方案 |
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| Clinical Effects of Different Doses of Long-acting Gonadotropin Releasing Hormone Agonist (GnRH-a) Versus Daily Injections of Short-acting GnRH-a in IVF Cycles |
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| Abstract:Objective Clinical efficacy was compared among single injections of different doses of long acting gonadotropin releasing hormone agonist (GnRH-a), and daily injections of short-acting GnRH-a in order to evaluate different methods of ovarian stimulation for in vitro fertilization (IVF) cycles.Methods A retrospective study of 214 patients who underwent IVF assisted fertility treatments was conducted. Patients were allocated into four study groups:the short protocol (group A), in which daily injections of 0.1mg GnRH-a was administered in the mid-luteal phase until the day of human chorionic gonadotropin (hCG) administration (see below); or the long protocol (group B, C & D), in which single injections of 3.75mg, 2.0mg, or 0.9mg of long-acting GnRH-a was given in the mid-luteal phase, respectively. Stimulation with gonadotropins (Gn) started when pituitary down-regulation was established. When vaginal ultrasonographic scans showed that at least two follicles had reached 16-20mm in diameter, Gn stimulation was withdrawn, and serum estradiol (E2), progesterone (P), and luteinizing hormone (LH) were determined. Additionally, human chorionic gonadotropin (hCG) was administered that evening. Egg collection was performed 38 hours after hCG injection and the standard IVF procedure was performed.Results There were no statistically significant differences amongst the four groups when measuring serum LH levels, number of oocytes, number of fertilized eggs, number of good quality embryos, and clinical pregnancy rate. The total amount of Gn administered was almost identical when comparing group A and group D, as well as when comparing group B and group C. However, Group A and D required less Gn stimulation to exhibit follicles of 16-20mm in diameter, compared to group B and C (P<0.005). Moreover, there was a significant difference in the time required for ovulation induction between group A and group C, where group A had a shorter time to ovulation. The fertilization rate was statistically different between group B and other groups (P<0.005).Conclusion Through our data analysis, we conclude based on outcome, cost, side-effects, and simplification of treatments, that the 0.9mg long-acting GnRH-a treatment is eminent for ovarian stimulation for IVF. |
| keywords:Gonadotropin releasing hormone agonist (GnRH-a) In vitro fertilization-embryo transfer (IVF-ET) Pituitary down-regulation Long protocol of controlled ovarian hyperstimulation |
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