摘要
目的探讨促性腺激素释放激素拮抗剂(GnRH-ant)方案与促性腺激素释放激素激动剂(GnRH-a)长方案在多囊卵巢综合征(polycystic ovary syndrome,PCOS)高反应患者的临床运用及疗效比较。方法回顾性分析2015年1月至2017年12月在本中心行体外受精胚胎移植或卵胞浆内单精子注射(IVF/ICSI)的PCOS高反应患者,获卵数>20个,预防中重度卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)取消新鲜移植后行冷冻周期移植的共727个周期,其中GnRH-ant方案163个周期,GnRH-a长方案564个周期。比较两组患者的临床资料及临床疗效。结果 GnRH-ant方案组Gn用量、Gn天数、获卵数、成熟卵子数、正常受精率明显低于GnRH-a长方案组(P <0.05);GnRH-ant方案组优胚率显著高于GnRH-a长方案组(P <0.05)。两组中成熟卵子率、优胚数、重度OHSS发生率、ET日内膜厚度、临床妊娠率、生化妊娠率、种植率、活产率、流产率、宫外孕率、早产率及低出生体重周期率等差异均无统计学意义(P> 0.05)。结论对于PCOS高反应获卵数>20个的患者,GnRH-ant方案比GnRH-a长方案能在减少Gn用量,缩短Gn时间的前提下获得更高的优胚率;联合冻融胚胎移植,GnRH-ant方案组妊娠结局与GnRH-a长方案相当;在使用HCG扳机的前提下,GnRH-ant方案在降低中重度OHSS发生率方面未能体现优势。
Objective To evaluate the clinical effects of GnRH antagonist(GnRH-ant)protocol versus GnRH agonist(GnRH-a)long protocol in high responders PCOS patients. Methods The retrospective analysis was performed on 727 frozen-thawed embryo transfer(FET)cycles which canceled embryo transfer during fresh IVF/ICSI cycles from January 2015 to August 2017,including 564 cycles of GnRH-a long protocol and 163 cycles of GnRH-ant protocol. The data of during the whole process were analyzed and the clinical outcome of all in FET cycles were explored. Results Compared with GnRH-a long protocol group,GnRH-ant protocol group showed lower level of Gn dosage,days of Gn administered,number of retrieved oocytes,number of matured oocytes,Normal fertilization rate. GnRH-ant protocol group possessed higher high-quality embryos rate than GnRH-a long protocol group. There was no significant difference in of matured oocytes,number of high-quality embryos,sever OHSS incidence,endometrial thickness on day of ET,clinical pregnancy rate,biochemical pregnancy rate,implantation rate,live birth rate,miscarriage rate,ectopic pregnancy rate,premature birth rate and low birth weight infant rate. Conclusion In high responder PCOS patients with high numbers(> 20)of retrieved oocytes,compared with GnRH-a long protocol,GnRH-ant protocol shows less Gn dosage,days of Gn administered and higher high-quality embryos rate,but shows comparable pregnancy outcome in FET and no significant benefits in reducing sever OHSS rate with HCG triggered.
作者
黄菊
董梅
黄莉
徐丽清
黄翠玉
HUANG Ju;DONG Mei;HUANG Li;XU Liqing;HUANG Cuiyu(Guangdong Women and Children Hospital,Guangzhou 511442,China)
出处
《实用医学杂志》
CAS
北大核心
2019年第18期2909-2913,共5页
The Journal of Practical Medicine
基金
广东省医学科学技术研究基金项目(编号:A2016200)
