GnRH拮抗剂固定方案和GnRH激动剂长方案在卵巢储备功能正常的不孕患者初次IVF-ET中的疗效比较

摘要

目的 比较促性腺激素释放激素(GnRH)拮抗剂固定方案和GnRH激动剂长方案在卵巢储备功能正常的不孕患者初次控制性促排卵及体外受精-胚胎移植(IVF-ET)治疗中的效果,探讨GnRH拮抗剂固定方案应用于卵巢储备功能正常不孕患者的可行性和优越性.方法 选择2011年1至6月于北京大学第三医院进行初次控制性促排卵及IVF-ET助孕的不孕症患者771例,其中245例采用GnRH拮抗剂固定方案(拮抗剂组,245个周期),526例采用低剂量长效GnRH激动剂长方案(激动剂组,526个周期).对患者的一般情况、治疗及妊娠结局进行比较.结果 两组患者年龄、不孕年限、体质指数及基础卵泡刺激素、雌二醇水平比较,差异均无统计学意义(P＞0.05).拮抗剂组和激动剂组hCG注射日雌二醇水平分别为(12 289±6856) pmol/L和(14 934±8007) pmol/L,促性腺激素平均应用时间分别为(10.3±1.2)d和(12.8±1.6)d,促性腺激素用量分别为(2013±607)U和(2646±913)U,取卵数分别为(15±7)个和(17±8)个,两组分别比较,差异均有统计学意义(P＜0.05).拮抗剂组和激动剂组可利用胚胎数分别为(7±4)个和(8±5)个,取消周期分别为15个和52个,临床妊娠率分别为40.9％(94/230)和45.6％(216/474),胚胎种植率分别为26.1％(128/490)和30.9％(307/994),持续妊娠率分别为38.7％(89/230)和42.6％( 202/474),两组比较,差异均无统计学意义(P＞0.05).拮抗剂组和激动剂组中、重度卵巢过度刺激综合征发生率分别为2.4％(6/245)和4.2％(22/526),两组比较,差异无统计学意义(P＞0.05).结论 对于初次接受控制性促排卵及IVF-ET助孕且卵巢储备功能正常的不孕患者,GnRH拮抗剂固定方案与GnRH激动剂长方案有同样满意的临床结局,且更方便、经济、安全.%Objective To compare the clinical outcomes of gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) fixed protocol with GnRH agonist (GnRH-a) long protocol in infertile patients with normal ovarian reserve function in their first in vitro fertilization-embryo transfer (IVF-ET) cycle,and to explore the feasibility and advantage of GnRH antagonist protocol performed in normal responders.Methods From January 2011 to June 2011,771 infertile women with normal ovarian reserve function underwent their first IVF or intracytoplasmic sperm injection (ICSI) cycles in Peking University Third Hospital,which were divided into 245 cycles in GnRH-ant fixed protocol group ( GnRH-ant group) and 526 cycles in GnRH-a long protocol group ( GnRH-a group).The data of general demographic,treatment and clinical outcome were compared between two groups.Results Age,infertile duration,body mass index (BMI),baseline serum follicle-stimulating hormone (FSH) and estradiol levels between two groups did not reached statistical difference (P ＞ 0.05 ).The level of estradiol was (12 289 ± 6856) pmol/L in GnRH-ant group and (14934±8007)pmol/L in GnRH-a group at day of hCG injection.The mean length of stimulation was ( 10.3 ± 1.2) days in GnRH-ant group and ( 12.8 ± 1.6) days in GnRH-a group.The dose of gonadotropin was (2013 ± 607 ) U in GnRH-ant group and (2646 ± 913 ) U in GnRH-a group.The number of ovum was 15 ± 7 in GnRH-ant group and 17 ± 8 in GnRh-a group.Those clinical parameter all reached statistical difference (P ＜0.05 ).The number of embryo was 7 ±4 in GnRH-ant group and 8 ± 5 in GnRH-a group,the rate of clinical pregnancy was 40.9％ (94/230) in GnRH-ant group and 45.6％ (216/474)in GnRH-a group,the rate of implantation was 26.1％ (128/490)in GnRH-ant group and 30.9％ (307/994) in GnRH-a group,the rate of continuing pregnancy was 38.7％ ( 89/230 ) in GnRH-ant group and 42.6％ (202/474) in GnRH-a group,those parameter did not reach statistical difference (P ＞ 0.05).The rate of moderate or severe ovarian hyperstimulation syndrome was 2.4％ ( 6/245 ) in GnRH-ant group and 4.2％ (22/526) in GnRH-a group,which did not show significant difference ( P ＞ 0.05 ).Conclusion In the first IVF or ICSI cycle of the patients with normal ovarian reserve function,the fixed GnRH-ant protocol could get the same satisfied clinical outcome,and it is more economic,convenient and safer compared with low dose depot GnRH-a long protocol.