中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2012年
4期
245-249
,共5页
杨硕%陈新娜%乔杰%刘平%李蓉%陈贵安%马彩虹
楊碩%陳新娜%喬傑%劉平%李蓉%陳貴安%馬綵虹
양석%진신나%교걸%류평%리용%진귀안%마채홍
促性腺素释放激素%临床方案%排卵诱导%胚胎移植%受精,体外%妊娠率
促性腺素釋放激素%臨床方案%排卵誘導%胚胎移植%受精,體外%妊娠率
촉성선소석방격소%림상방안%배란유도%배태이식%수정,체외%임신솔
Gonadotropin-releasing hormone%Clinical protocols%Ovulation induction%Embryo transfer%Fertilization in vitro%Pregnancy rate
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.
目的 比較促性腺激素釋放激素(GnRH)拮抗劑固定方案和GnRH激動劑長方案在卵巢儲備功能正常的不孕患者初次控製性促排卵及體外受精-胚胎移植(IVF-ET)治療中的效果,探討GnRH拮抗劑固定方案應用于卵巢儲備功能正常不孕患者的可行性和優越性.方法 選擇2011年1至6月于北京大學第三醫院進行初次控製性促排卵及IVF-ET助孕的不孕癥患者771例,其中245例採用GnRH拮抗劑固定方案(拮抗劑組,245箇週期),526例採用低劑量長效GnRH激動劑長方案(激動劑組,526箇週期).對患者的一般情況、治療及妊娠結跼進行比較.結果 兩組患者年齡、不孕年限、體質指數及基礎卵泡刺激素、雌二醇水平比較,差異均無統計學意義(P＞0.05).拮抗劑組和激動劑組hCG註射日雌二醇水平分彆為(12 289±6856) pmol/L和(14 934±8007) pmol/L,促性腺激素平均應用時間分彆為(10.3±1.2)d和(12.8±1.6)d,促性腺激素用量分彆為(2013±607)U和(2646±913)U,取卵數分彆為(15±7)箇和(17±8)箇,兩組分彆比較,差異均有統計學意義(P＜0.05).拮抗劑組和激動劑組可利用胚胎數分彆為(7±4)箇和(8±5)箇,取消週期分彆為15箇和52箇,臨床妊娠率分彆為40.9％(94/230)和45.6％(216/474),胚胎種植率分彆為26.1％(128/490)和30.9％(307/994),持續妊娠率分彆為38.7％(89/230)和42.6％( 202/474),兩組比較,差異均無統計學意義(P＞0.05).拮抗劑組和激動劑組中、重度卵巢過度刺激綜閤徵髮生率分彆為2.4％(6/245)和4.2％(22/526),兩組比較,差異無統計學意義(P＞0.05).結論 對于初次接受控製性促排卵及IVF-ET助孕且卵巢儲備功能正常的不孕患者,GnRH拮抗劑固定方案與GnRH激動劑長方案有同樣滿意的臨床結跼,且更方便、經濟、安全.
목적 비교촉성선격소석방격소(GnRH)길항제고정방안화GnRH격동제장방안재란소저비공능정상적불잉환자초차공제성촉배란급체외수정-배태이식(IVF-ET)치료중적효과,탐토GnRH길항제고정방안응용우란소저비공능정상불잉환자적가행성화우월성.방법 선택2011년1지6월우북경대학제삼의원진행초차공제성촉배란급IVF-ET조잉적불잉증환자771례,기중245례채용GnRH길항제고정방안(길항제조,245개주기),526례채용저제량장효GnRH격동제장방안(격동제조,526개주기).대환자적일반정황、치료급임신결국진행비교.결과 량조환자년령、불잉년한、체질지수급기출란포자격소、자이순수평비교,차이균무통계학의의(P＞0.05).길항제조화격동제조hCG주사일자이순수평분별위(12 289±6856) pmol/L화(14 934±8007) pmol/L,촉성선격소평균응용시간분별위(10.3±1.2)d화(12.8±1.6)d,촉성선격소용량분별위(2013±607)U화(2646±913)U,취란수분별위(15±7)개화(17±8)개,량조분별비교,차이균유통계학의의(P＜0.05).길항제조화격동제조가이용배태수분별위(7±4)개화(8±5)개,취소주기분별위15개화52개,림상임신솔분별위40.9％(94/230)화45.6％(216/474),배태충식솔분별위26.1％(128/490)화30.9％(307/994),지속임신솔분별위38.7％(89/230)화42.6％( 202/474),량조비교,차이균무통계학의의(P＞0.05).길항제조화격동제조중、중도란소과도자격종합정발생솔분별위2.4％(6/245)화4.2％(22/526),량조비교,차이무통계학의의(P＞0.05).결론 대우초차접수공제성촉배란급IVF-ET조잉차란소저비공능정상적불잉환자,GnRH길항제고정방안여GnRH격동제장방안유동양만의적림상결국,차경방편、경제、안전.
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.
