附属第三医院生殖医学中心,广东,广州,510630
网络首发:2017-09-16,
纸质出版:2017
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朱洁茹, 欧建平, 邢卫杰, 等. GnRH激动剂长方案与GnRH拮抗剂方案在不同年龄组、不同反应人群中的新鲜周期临床结局比较[J]. 中山大学学报(医学科学版), 2017,38(5).
Comparison of the Clinical Outcomes of Fresh Embryo Transfer with GnRH Agonist Long Protocol Versus GnRH Antagonist Protocol in Different Age Groups and Different Responders[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017, 38(5).
朱洁茹, 欧建平, 邢卫杰, 等. GnRH激动剂长方案与GnRH拮抗剂方案在不同年龄组、不同反应人群中的新鲜周期临床结局比较[J]. 中山大学学报(医学科学版), 2017,38(5). DOI:
Comparison of the Clinical Outcomes of Fresh Embryo Transfer with GnRH Agonist Long Protocol Versus GnRH Antagonist Protocol in Different Age Groups and Different Responders[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017, 38(5). DOI:
目的】比较促性腺激素释放激素激动剂(GnRH-a)长方案和促性腺激素释放激素拮抗剂(GnRH-ant)方案在 不同年龄组和不同反应人群中行体外受精或单精子卵胞浆内注射-胚胎移植(IVF/ICSI-ET)新鲜周期移植的临床结局。 【方法】回顾性分析中山大学附属第三医院生殖医学中心2015年8月28日至2016年12月31日行IVF/ICSI的737个周期,其 中GnRH-a长方案(A组)386个周期,GnRH-ant方案(B组)351个周期。按年龄和获卵数分成a和b两个亚组:a1组(< 38 岁),a2组(≥ 38岁);b1组(获卵数≤ 5个),b2组(获卵数6 ~ 15个),b3组(获卵数> 15个)。比较患者的临床资料和助孕结 局。【结果】(1)A、B两组的受精率、正常受精率、生化妊娠率、流产率均无统计学差异,A组的促性腺激素(Gn)使用天数、Gn 总量、人绒毛膜促性腺激素(hCG)日雌二醇(E 2 )浓度、hCG日内膜厚度、获卵数、成熟卵子数、卵巢过度刺激综合征(OHSS) 发生率、胚胎种植率、临床妊娠率均高于B组(P < 0.05),B组的新鲜周期移植取消率高于A组(P < 0.001)。(2)按年龄分层 后,< 38岁亚组使用GnRH-ant方案的胚胎种植率略低于GnRH-a长方案(32.6% vs 39.8%,P = 0.067),两种方案的临床妊娠 率没有统计学差异(54.8% vs 50.4%,P = 0.429);≥38岁亚组使用GnRH-ant方案的胚胎种植率低于GnRH-a长方案(9.7% vs 17.9%,P = 0.066),使用 GnRH-ant 方案的临床妊娠率低于 GnRH-a 长方案(19.6% vs 39.1%),差异有统计学意义(P = 0.021)。(3)按获卵数分层后,除b1亚组GnRH-ant方案的胚胎种植率低于GnRH-a长方案以外(13.1% vs 26.0%,P = 0.026), b2、b3亚组使用两种方案的胚胎种植率没有统计学差异;b1、b2、b3三个亚组使用两种方案的临床妊娠率均没有统计学差 异,但是b1亚组两种方案的临床妊娠率相差较大(36.6% vs 19.3%,P = 0.056)。【结论】总体而言,GnRH-a长方案的胚胎种 植率和临床妊娠率高于GnRH-ant方案,但GnRH-ant方案可降低Gn的用量,缩短治疗时间,并有效减少OHSS的发生。对 于年轻的卵巢正常反应患者甚至是高反应患者,两种方案有相似的临床结局;而对于高龄等低反应患者,则使用GnRH-a长 方案的胚胎种植率和临床妊娠率更高。
【Objective】To compare the clinical outcomes of fresh embryo transfer of the in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)in different age groups as well as in different responders using gonadotropin-re? leasing hormone agonist(GnRH-a)long protocol or GnRH antagonist(GnRH-ant)protocol.【Methods】A retrospective analysis was performed on 737 IVF/ICSI cycles,including 386 cycles of GnRH-a long protocol(group A)and 351 cycles of GnRH-ant protocol (group B),from August 28,2015 to December 31,2016. Then all the cycles were divided into sub-groups by ages and retrieved oo? cyte numbers:group a1(< 38 years),group a2(≥ 38 years);group b1(n ≤ 5),group b2(6 ≤ n ≤ 15),group b3(n > 15). Thebasic information of patients and clinical outcomes were compared.【Results】(1)Comparable results were obtained from group A and group B in these following variables such as fertilization rate,normal fertilization rate,biochemical pregnancy rate and miscarriage rage. But the stimulation period,the total gonadotropin(Gn)dosage,estradiol(E2)level and endometrial thickness on the day of human chorionic gonadotropin(hCG)administration,number of oocytes retrieved and mature oocytes,ovarian hyperstimulation syn? drome(OHSS)rate,implantation rate and clinical pregnancy rate were significantly higher in group A than group B(P < 0.05),and significantly higher cancellation rate of fresh embryo transfer was observed in group B(P < 0.001).(2)When divided by ages,no mat? ter in sub-group a1 or sub-group a2,the implantation rate was slightly lower in GnRH-ant protocol than in GnRH-a long protocol, although they failed to reach significant difference(sub-group a1:32.6% vs 39.8%,P = 0.067;sub-group a2:9.7% vs 17.9%,P = 0.066). The clinical pregnancy rate was comparable using these two protocols in sub-group a1(54.8% vs 50.4%,P = 0.429),but it was significantly lower by using GnRH-ant protocol than GnRH-a long protocol in sub-group a2(19.6% vs 39.1%,P = 0.021). (3) When divided by numbers of oocytes retrieved,the implantation rate was significantly lower when using GnRH-ant protocol in sub- group b1(13.1% vs 26.0%,P = 0.026),but we failed to observe significant differences in other two sub-groups. The clinical preg? nancy rates were comparable in all sub-groups,whereas differed considerably in sub-group b1(36.6% vs 19.3%,P = 0.056). 【Conclusion】Overall,the implantation rate and clinical pregnancy rate were higher in GnRH-a long protocol than those in GnRH- ant protocol. Nevertheless,GnRH-ant protocol could reduce the dosage of Gn,shorten the treatment duration,and effectively reduce the occurrence of OHSS. There were similar pregnancy outcomes in two protocols for normal responders and high responders,while for advanced patients or other poor responders,the implantation rate and clinical pregnancy rate were higher in GnRH-a protocol.
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