摘要
目的探讨促性腺激素激动剂(GnRH-a)联合小剂量人绒毛膜促性腺激素(hCG)诱发排卵对卵巢高反应患者体外受精-胚胎移植的临床结局影响。方法回顾性分析2016年12月至2017年12月在南京医科大学附属妇产医院本中心采取GnRH拮抗剂方案进行控制性超促排卵,行体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕的546例患者的临床资料,将因卵巢高反应分别使用GnRH-a联合5000 U hCG促排卵(hCG大剂量组,n=159)及GnRH-a联合2000 U hCG促排卵(hCG小剂量组,n=212)的患者作为研究组,同期采用标准的hCG 10000 U促排卵的患者作为对照组(n=175),比较各组患者的治疗结局。结果三组患者促性腺激素(Gn)启动剂量及用药时间比较,差异均无统计学意义(P>0.05)。hCG大剂量组患者hCG促排卵日血清雌二醇(E2)水平[(17513.52±4846.85)pmol/L]及hCG小剂量组患者[(20384.11±7754.78)pmol/L]显著高于对照组患者[(16678.67±3826.79)pmol/L](P=0.000)。两研究组的获卵数、2PN数、胚胎数、优胚数及优胚率方案高于对照组(P<0.05),同时hCG大剂量组优胚率均高于hCG小剂量组(P<0.05)。hCG大剂量组、小剂量组与对照组三组间卵巢过度刺激综合征(OHSS)率(1.3%、0.5%、2.9%)发生率比较,差异无统计学意义(P>0.05)。结论对于GnRH拮抗剂方案的高反应患者,采用减量联合促排卵方案,可提高优胚率及可移植胚胎数,不增加OHSS发生率。
Objective To investigate the effect of gonadotropin-releasing hormone agonist(GnRH-a)combined with low-dose human chorionic gonadotrophin(hCG)on the clinical outcome of in-vitro fertilization-embryo transfer(IVF-ET)in patients with high ovarian response.Methods A retrospective analysis was performed on the clinical data of 546 patients who underwent controlled superovulation stimulation via(IVF/ICSI)in our hospital from December 2016 to December 2017.Patients adopting GnRH-a+5000 IU hCG dual-trigger(hCG high dose group,n=159)orGnRH-a+2000 IU hCG dual-trigger(hCG low dose group,n=212)were enrolled.Those using the standard hCG 10000 IUtrigger were involved as a control group.The treatment outcome of each group was compared.Results There was no significant differences in basic dosage or medication time of gonadotropin trigger among the three groups(P>0.05).The serum levels of estradiol(E2)on ovulation induction day in the high-dose hCG group[(17513.52±4846.85)pmol/L]and the low-dose hCG group[(20384.11±7754.78)pmol/L]were significantly higher than those in the controlgroup[(16678.67±3826.79)pmol/L](P=0.000).The number of retrieved oocytes,number of 2PN embryos,number of embryos,number of high-quality embryos,and rate of high-quality embryos in both test groups were all significantly higher than incontrol group(P<0.05).The rate of high-quality embryos in hCG high dose group was significantly larger than in hCG low dose group.There were no statistically significant differences in clinical pregnancy rates(53.7%,50.0%,51.9%),ectopic pregnancy rates(10.3%,14.3%,0%)and abortion rates(10.3%,0%,7.1%)among the three groups,Tnumber of ovarian hyperstimulation syndrome(OHSS)and the incidence of OHSS rate(2.9%,1.3%,0.5%)were not significantly different(P>0.05).Conclusion For patients with high response to GnRH antagonist regimen,the use of low-dosage dual-trigger can increase the rate of high-quality embryos and the number of transferrable embryos without increasing the incidence of OHSSs.
作者
李欣
凌秀凤
赵纯
张军强
张娟
LI Xin;LING Xiufeng;ZHAO Chun;ZHANG Junqiang;ZHANG Juan(Center of Reproduction Medicine,Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University,Nanjing 210000,China)
出处
《中国妇产科临床杂志》
CSCD
北大核心
2020年第2期133-137,共5页
Chinese Journal of Clinical Obstetrics and Gynecology
基金
国家自然科学基金项(81471457)
南京医科大学科技发展基金面上项目(2017NJMU075).
