吉林大学学报(医学版) ›› 2022, Vol. 48 ›› Issue (5): 1284-1289.doi: 10.13481/j.1671-587X.20220523

• 临床研究 • 上一篇    

不孕患者不同时期应用GnRH拮抗剂方案与GnRH激动剂长方案疗效的比较

赵浩,张叶青,郭吉红,夏秋平,田芬()   

  1. 中南大学湘雅医院生殖医学中心,湖南 长沙 410008
  • 收稿日期:2021-12-06 出版日期:2022-09-28 发布日期:2022-11-15
  • 通讯作者: 田芬 E-mail:9637149@qq.com
  • 作者简介:赵 浩(1988-),男,湖南省邵东市人,主管技师,医学博士,主要从事薄型子宫内膜血管再生方面的研究。
  • 基金资助:
    国家自然科学基金项目(81701437);湖南省科技厅自然科学基金青年基金项目(2022JJ40844)

Comparison of curative effects between GnRH antagonist and GnRH agonist in infertile patients at different periods

Hao ZHAO,Yeqing ZHANG,Jihong GUO,Qiuping XIA,Fen TIAN()   

  1. Reproductive Medicine Center,Xiangya Hospital,Central South University,Changsha 410008,China
  • Received:2021-12-06 Online:2022-09-28 Published:2022-11-15
  • Contact: Fen TIAN E-mail:9637149@qq.com

摘要:

目的 探讨促性腺激素释放激素拮抗剂(GnRH-ant)方案和GnRH激动剂(GnRH-a)长方案在同一不孕患者中新鲜胚胎移植的妊娠结局,为促排卵方案的选择提供依据。 方法 采用回顾性研究方法,收集2年内接受GnRH-ant方案和GnRH-a长方案促排卵助孕治疗的74例不孕患者(共148个周期)的临床资料和实验室检查资料,分析2种促排卵方案的促排卵效果、胚胎发育情况和新鲜周期移植的临床结局。 结果 促排卵情况,与GnRH-a组比较,GnRH-ant组患者促性腺激素(Gn)总用量、使用天数和内膜厚度均降低(P<0.05或P<0.01);血清中人绒毛膜促性腺激素(HCG)日黄体生成素(LH)水平明显升高(P<0.01);获卵数和HCG日血清中孕酮(P)及雌二醇(E2)水平差异无统计学意义(P>0.05)。胚胎情况,与GnRH-a组比较,GnRH-ant组患者2个原核(2PN)率、异常受精率、2PN卵裂率、可用囊胚形成率和优质囊胚形成率均升高,但差异无统计学意义(P>0.05);GnRH-ant组患者优胚率和可利用胚胎率明显升高(P<0.05)。临床妊娠结局,2组患者移植胚胎数目、异位妊娠率、流产率、种植率和临床妊娠率比较差异均无统计学意义(P>0.05)。 结论 GnRH-ant方案周期优胚率和可利用胚胎率高于GnRH-a长方案,Gn使用剂量更低且使用时间更短,可能是更适宜的促排卵方案。

关键词: 拮抗剂方案, 卵泡期长效长方案, 胚胎移植, 体外受精

Abstract:

Objective To investigate the pregnancy outcomes of fresh embryo transfer in the same infertile patients receiving the GnRH antagonist (GnRH-ant) program and the GnRH agonist (GnRH-a) program for ovulation, and to provide basis for the selection of ovulation induction program. Methods Using retrospectively research method, the clinical data and laboratory examination data of 74 patients (148 cycles in total) received GnRH-a program and GnRH-ant program treatment for ovulation within 2 years were collected. The effects of ovulation promotion, embryo development and clinical outcome of fresh cycle transplantation were analyzed. Results The ovulation induction detection results showed that compared with GnRH-a group, the total dose and time of gonadotropin (Gn) use, and endometrial thickness of the patients in GnRH-ant group were decreased (P<0.05 or P<0.01); the level of luteinizing hormone (LH) on the human chorionic gonadotropin (HCG) day was significantly increased (P<0.01);there were no significant differences in the number of oocytes retrieved and the levels of progesterone(P) and estradiol(E2) on the HCG day (P>0.05). The embryo status detection results showed that compared with GnRH-a group,the 2 pronucleus(2PN) rate, abnormal fertilization rate,2PN cleavage rate, available blastocyst formation rate and high quality blastocyst formation rate in GnRH-ant group were increased, but there were no significant differences (P>0.05),while the good embryo rate and available embryo rate in GnRH-ant group were significantly increased (P<0.05).In clinical pregnancy outcome, there were no significant differences in the number of embryos transferred, ectopic pregnancy rate, abortion rate, implantation rate and clinical pregnancy rate in two groups (P>0.05). Conclusion GnRH-ant program could be a more suitable plan for ovulation due to the higher good embryo rate, avaliable embryo rate, lower Gn dose and shorter Gn using time compared with GnRH-a program.

Key words: Gonadotropin releasing hormone antagonist program, Gonadotropin releasing hormone agonist program, Embryo transfer, In vitro fertilization

中图分类号: 

  • R271.14