早卵泡期促性腺激素释放激素激动剂降调节联合人绝经期促性腺激素在卵巢储备功能低下者促排卵中应用

中国临床药理学与治疗学 ›› 2011, Vol. 16 ›› Issue (9): 1033-1038.

早卵泡期促性腺激素释放激素激动剂降调节联合人绝经期促性腺激素在卵巢储备功能低下者促排卵中应用

余蓉, 赵军招, 肖仕全, 王佩玉, 林佳, 杨海燕

温州医学院附属第一医院生殖中心,温州 325000,浙江

收稿日期:2011-07-12 修回日期:2011-08-19 出版日期:2011-09-26 发布日期:2011-10-11
通讯作者: 赵军招,女,硕士,教授,主任医师,研究方向:生殖内分泌。Tel: 13806890385 E-mail: joyce671128@163.com
作者简介:余蓉,女,硕士,住院医生,研究方向:生殖内分泌。Tel: 13615779108 E-mail: nerve1116@163.com

Clinical application of Gonadotropin-release hormone agonist (GnRH-a) down-regulation in early follicle phase combined with ovarian stimulation by human menopausal gonadotropin (HMG) protocol for patients who have decreased ovarian reserve

YU Rong, ZHAO Jun-zhao, XIAO Shi-quan, WANG Pei-yu, LIN Jia, YANG Hai-yan

Department of Reproductive Medicine, First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang, China

Received:2011-07-12 Revised:2011-08-19 Online:2011-09-26 Published:2011-10-11

摘要/Abstract

摘要： 目的: 探讨促性腺激素释放激素激动剂(GnRH-a)早卵泡期降调节联合尿促性腺激素(HMG)方案用于卵巢储备功能低下不孕患者超促排卵的临床疗效。方法: 回顾性分析2010年5月至2011年3月行体外受精(IVF)或单精子卵胞浆内注射(ICSI)治疗的109例卵巢储备功能下降患者的新鲜周期。根据促排方案分为早卵泡期降调节组(A)、微刺激组(B)和短方案组(C)。比较3组患者的临床及实验室结局。结果: B组患者促性腺激素用量低于A、C组患者,差异有显著统计学意义(P<0.01)。注射人绒毛膜促性腺激素(HCG)日,A组患者血清黄体生成素(LH)水平显著低于B、C组,C组患者血清E₂水平显著高于A、B组,差异均有显著统计学意义(P<0.01)。3组患者获卵数、卵子成熟率、受精率和移植胚胎数比较均无统计学差异(P>0.05)。3组每移植周期临床妊娠率比较无统计学差异(33.33% vs 32.35% vs 36.00%, P>0.05)。B组周期取消率(34.62%)高于A组(11.11%),差异有统计学意义(P=0.02),与C组(16.67%)比较差异无统计学意义(P＝0.05)。C组孕早期流产率(33.33%)高于A组(12.50%)和B组(18.18%),差异均有统计学意义(P＝0.028,P＝0.03)。结论: 对于卵巢储备功能低下的不孕患者采用GnRH-a卵泡期长方案联合HMG促排卵,可获得与微刺激和短方案相同的临床妊娠率,且周期取消率和妊娠早期自然流产率降低。

关键词: 促性腺激素释放激素激动剂, 人绝经期促性腺激素, 卵巢储备

Abstract: AIM: To investigate the effect of the GnRH-a down-regulation in early follicle phase combined with ovarian stimulation by HMG protocol for patients who have decreased ovarian reserve. METHODS: Clinical retrospective analysis was performed on 109 cycles in total 109 patients received IVF or ICSI treatment between May 2010 and March 2011. The 109 cycles were divided into three groups by stimulation protocol. Group A consisted of cycles with GnRH-a down-regulation protocol. Group B consisted of cycles with mild stimulation protocol. Group C consisted of cycles with GnRH-a flare-up protocol. The clinical and laboratory outcome of three groups were compared. RESULTS: The gonadotropin used in Group B was significantly less than that of Group A and C(P<0.01). The serum level of LH in Group A was significantly lower than that of Group B and C(P<0.01). Group C showed a significant higher level of E₂ compared with Group A and B (P<0.01). No significant difference was observed in the number of oocytes retrieved and the rate of maturation and fertilization(P>0.05). There was no significant difference in the clinical pregnancy rate per transfer in three groups(33.33% vs 32.35% vs 36.00%, P>0.05). The cancel rate was significantly higher in Group B (34.62%) when compared with Group A (11.11%)(P=0.02), but the difference was not significant when it was compared with Group C (16.67%)(P＝0.05).The first-trimester abortion rate of Group C (33.33%)was significantly higher than that of Group A (12.50%, P＝0.028) and Group B (18.18%,P＝0.03). CONCLUSION: GnRH-a down-regulation in early follicle phase combined with HMG protocol could reach a comparable pregnancy rate as mild stimulation protocol and GnRH-a flare-up protocol for patient with decreased ovarian reserve. Furthermore, the cancel rate and the first-trimester abortion rate could be decreased.

Key words: Gonadotropin-releasing hormone agonist, Human menopausal gonadotrophin, Ovarian reserve

中图分类号:

余蓉, 赵军招, 肖仕全, 王佩玉, 林佳, 杨海燕. 早卵泡期促性腺激素释放激素激动剂降调节联合人绝经期促性腺激素在卵巢储备功能低下者促排卵中应用[J]. 中国临床药理学与治疗学, 2011, 16(9): 1033-1038.

YU Rong, ZHAO Jun-zhao, XIAO Shi-quan, WANG Pei-yu, LIN Jia, YANG Hai-yan. Clinical application of Gonadotropin-release hormone agonist (GnRH-a) down-regulation in early follicle phase combined with ovarian stimulation by human menopausal gonadotropin (HMG) protocol for patients who have decreased ovarian reserve[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(9): 1033-1038.

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