摘要
目的探讨促性腺激素释放激素拮抗剂(GnRH拮抗剂)配伍HMG方案对卵巢低反应患者控制性超排卵的效果,及其对体外受精-胚胎移植结局的影响。方法研究对象为前次IVF-ET治疗失败,证明是卵巢低反应,要求再次IVF-ET治疗的患者,随机分为2组,实验组使用GnRH拮抗剂+HMG方案,共21个周期,对照组使用GnRH激动剂短方案,共23个周期。将两组患者的年龄、基础FSH水平、Gn使用天数和剂量、hCG日血清E2水平、获卵数、受精率、临床妊娠率、胚胎种植率等进行比较。结果两组患者不孕年限、与前次IVF-ET间隔时间、周期取消率、Gn使用天数、HCG日E2水平、获卵数、受精方式、受精率,胚胎移植数等比较差异均无显著性(P>0.05)。拮抗剂组与激动剂组的平均年龄分别为:(37.7±3.3)岁和(35.9±4.1)岁;平均基础FSH分别为:(14.21±6.76)μ/L和(10.04±4.60)μ/L。平均Gn使用量:拮抗剂组为(32.3±17.8)支,激动剂组为(39.8±12.2)支。拮抗剂组与激动剂组的临床妊娠和胚胎种植率分别为(42.1%vs10.5%)和(25.7%vs5.0%),两组患者的年龄、基础FSH、平均Gn用量、临床妊娠率、胚胎种植率等比较差异均有显著性(P<0.05)。结论GnRH拮抗剂与HMG配伍,对卵巢低反应的患者是一种有效的超排卵治疗方案,可以提高IVF-ET的临床妊娠率和胚胎种植率,并且费用低廉。
Objective To compare the effect of the treatment of gonadotrophin- releasing hormone antagonist （GnRH） plus HMG to the standard GnRH agonists short protocol for poor responders. Methods A prospective cohort study was conducted for 44 patients who had failed in previous IVF - ET treatment and were proved to be poor responders. They were randomly derided into two groups： GnRH _ ant plus HMG group which included 21 cycles using GnRH _ ant plus HMG; GnRH _ a short protocol which included 23 cycles using GnRH _ a plus rFSH＋HMG （half rFSH and half HMG） as control. Results No significant differences were found in the two groups in the infertility duration, the interval to the last IVF- ET cycle, rate of canceling cycle, days of Gn stimulating and peak estradiol level, OCCs numbers of retrival , fertility rate and embryo numbers of transferred （P〉0. 05）. The GnRH ant plus HMG group was older （37.7±3.3） vs （35.9±4.1） years, （P=0. 021）, and had higher base FSH level （14.21±6.67） vs （10. 04±4.60） （P=0. 001） than the group of GnRH _a short protocol. In contrast, less Gn was used in GnRH _ ant plus HMG group than in GnRH a short protocol group （32.3±17.8） vs （39.8±12.2） ampul, （P= 0. 018）. Higher rates of pregnancy （42.1% vs 10. 5%, P=0. 031） and implantation （25.7% vs 5.0%, P=0. 013） were found in the group of GnRH ant plus HMG than control. Conclusions The protocol of GnRH _ ant plus HMG is effective for poor responders and it is an economic protocol as well.
出处
《中国妇产科临床杂志》
2008年第1期38-40,53,共4页
Chinese Journal of Clinical Obstetrics and Gynecology
