摘要
目的探讨体外受精-胚胎移植(IVF-ET)中应用半量长效促性腺激素释放激素激动剂(GnRHa)降调节后,延迟超促排卵(COH)启动时间对实验室和临床结局等的影响。方法将IVF中207个周期分为对照、常规和延迟组:对照组98周期于黄体中期予短效GnRHa0.1mg/d,月经第3d减半,常规组63周期和延迟组46周期于黄体中期予长效GnRHa1.87mg;对照组和常规组于月经第3d加用促性腺激素(Gn),延迟组于第7d加用Gn,观察在IVF-ET中临床和实验室的结局是否有差异。结果常规组的取消周期数最多(P<0.01)。COH启动日,延迟组和对照组E2、LH水平高于常规组(P均<0.01)。HCG注射日,对照组的E2水平最高;延迟组和对照组中LH水平高于常规组(P均<0.01),刺激天数和Gn用量少于常规组(P均<0.005),获卵数、受精率、可移植胚胎数、临床妊娠率、胚胎种植率和MⅡ期卵子高于常规组(P均<0.05);延迟组中重度卵巢过度刺激综合征(OHSS)的发生少于常规组。结论延迟COH启动时间可减少卵巢刺激时间、Gn用量,增加获卵数、成熟卵子数、可移植胚胎数和胚胎种植率,提高IVF的妊娠率。
Objective This study observed the influence on hormone, embryos and clinical outcomes when the starting time of controlled ovarian hyperstimulation （COH） was delayed after applying a half-dose depot gonadotropin-releasing hormone agonist （GnRHa）. Methods A total 207 cycles were divided into 3 groups： control group （98 cycles, which performed daily low dose GnRHa during the mid-luteal phase in patients＇ menstrual cycles and reduced the dosage to a half at the next day 3, and added gonadotropin （Gn）, conventional group （63 cycles, in which pituitary desensitization was obtained with a half-dose depot GnRHa in the mid-luteal phase, and then Gn was added at day 3） and delayed group （46 cycles, having the same usage of GnRHa to conventional group, but not adding Gn until day 7）. Results The cancellation rate of cycle in conventional group was the highest （P〈0. 01）. At the beginning of COH, serum E2 and LH levels in delayed and control group were significantly higher than those in conventional group （P〈0. 01）. On the day of HCG given, serum Ez level in control group was the highest （P〈 0. 05）. LH level in delayed and control group was higher than that in conventional group （P〈0.01）. Concerning the clinical efficacy and outcome, the numbers of Gn ampoules and periods for stimulation were less in delayed group than in conventional group. the numbers of retrieved and fertilized oocytes, numbers of good quality embryos , clinical pregnancy rate and embryo implantation rate in delayed and control groups were significantly more than those in conventional group （P〈0.01）. In ICSI cycles, the numbers of retrieved oocytes and metaphase K oocytes in delayed and control group were more than those in conventional group. Conclusions A half-dose depot GnRHa may produce over suppression to pituitary gland in fertilization in vitro, appropriate delay of COH starting time can decrease ovarian stimulation period and ampoules of Gn, and increase retrieved good quality oocytes, so we
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2007年第6期980-983,共4页
Journal of Sichuan University(Medical Sciences)
关键词
促性腺激素释放激素
激动剂
控制性超促排卵
体外受精
Gonadotropin-releasing hormone Agonist Controlled ovarian hyperstimulation In vitro fertilization
embryo transfer
