GnRH拮抗剂和GnRH激动剂在多囊卵巢综合征患者IVF-ET中的应用比较

摘要/Abstract

摘要： 目的探讨GnRH拮抗剂和激动剂对多囊卵巢综合征(PCOS)患者行体外受精-胚胎移植(IVF-ET)治疗的临床结局。方法研究2012年7月至2012年12月行IVF-ET治疗的PCOS患者共122个周期,按照患者意愿分成A、B两组,A组54个周期采用GnRH拮抗剂方案,B组68个周期采用GnRH激动剂长方案,比较两组的促性腺激素(Gn)用药量,人绒毛促性腺激素(HCG)日激素水平,获卵率、受精率等实验室结果,卵巢过度刺激综合征(OHSS)发生率及临床结局。结果 A组的Gn总用量和用药时间分别为(1 342.82±442.56) IU 和(9.67±2.06) d,显著低于B组的(1521.32±506.59) IU 和(12.01±3.62) d。A组HCG日雌二醇(E₂)(12 354.43±5 771.43) pmol/L, 显著高于B组的(8 685.26±4 218.03) pmol/L。A、B两组受精率分别为 79.3%和 73.76%,囊胚形成率分别为 39.33%和 30.71%,A组均明显高于B组。A、B两组的临床妊娠率分别为 44.90%和 66.67%,B组有增高趋势但差异无统计学意义。而两组其余实验室结果,OHSS发生率及临床结局均无统计学意义。结论与GnRH激动剂长方案相比,PCOS患者采用GnRH拮抗剂方案有效减少了Gn的用量和天数,减轻了患者的经济和心理负担,并提高了囊胚形成率,提高了累积妊娠率,是PCOS患者行IVF-ET较为适宜的促排卵方案之一。

关键词: GnRH拮抗剂, GnRH激动剂, 多囊卵巢综合征, 体外受精-胚胎移植, 卵巢过度刺激综合征

Abstract: AIM: To compare the effect of the GnRH antagonist and GnRH agonist on the outcomes of polycystic ovary syndrome patients who underwent in vitro fertilization and embryo transfer. METHODS: The study started from July 2012 to December 2012. A total of 122 patients with PCOS were divided into two groups according to the will of patients: 54 cycles in group A underwent GnRH antagonist protocol and 68 cycles in group B underwent routine GnRH agonist protocol. The dosage of gonadotropin, hormone levels, laboratory results, OHSS incidence and clinical outcomes were compared between the two groups. RESULTS:Total dosage and duration of gonadotropin of group A were (1 342.82±442.56) IU and (9.67±2.06) d, which was significantly lower than that of group B (1 521.32±506.59) IU and (12.01±3.62) days. E₂ on the day of HCG administration of Group A (12 354.43±5 771.43) pmol/L was significantly higher than that of group B (8 685.26±4 218.03) pmol/L. The fertilization rate and blastocyst formation rate of group A (79.3% and 73.76%) were significantly higher compared with group B (39.33% and 30.71%). The clinical pregnancy rates were 44.90% and 66.67% respectively. Group B had a rising trend but there had no significant difference. The other laboratory results, OHSS incidence and clinical outcomes were not significant difference. CONCLUSION: Compared with GnRH agonist protocol, GnRH antagonist protocol effectively reduced the amount and duration of gonadotriopin, cut down the costs and relieved the psychological burden. In addition, GnRH antagonist protocol improved the blastocyst formation rate, which may indirectly increased the cumulative pregnancy rate. We concluded that GnRH antagonist protocol may be an alternative method for PCOS patients.

Key words: GnRH antagonist, GnRH agonist, PCOS, IVF-ET, OHSS

中图分类号:

R588

王佩玉, 余蓉, 林金菊, 肖仕全, 金聪聪, 朱如如. GnRH拮抗剂和GnRH激动剂在多囊卵巢综合征患者IVF-ET中的应用比较[J]. 中国临床药理学与治疗学, 2014, 19(7): 795-800.

WANG Pei-yu, YU Rong, LIN Jin-ju, XIAO Shi-quan, JIN Cong-cong, ZHU Ru-ru. Comparison of GnRH antagonist and GnRH agonist used in IVF-ET in patients with PCOS[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(7): 795-800.

参考文献

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