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短效促性腺激素释放激素激动剂在冷冻周期移植中的 应用价值[J]. 中山大学学报(医学科学版), 2016,37(1).
Luteal Phase Support with GnRH -a Improves Pregnancy Rates in Natural Frozen -Thawed Blastocyst Transfer Cycles[J]. Journal of Sun Yat-sen University (Medical Sciences), 2016, 37(1).
摘 要: 【目的】 比较不同冷冻周期方案(人工周期和自然周期)囊胚移植后1 d应用短效促性腺激素释放激素激动剂( GnRH-a)对妊娠结局的影响。【方法】 回顾性分析2013年1月至2014年12月在我院行冷冻囊胚移植的患者657个周期,移植失败周期≤2次,月经周期规律,年龄在22 ~ 40岁之间,基础FSH水平小于10 U/mL,移植至少一个优质囊胚,且移植囊胚总数≤2个。根据冷冻周期方案分为4组,自然周期囊胚移植后1 d应用1次GnRH-a 0.1 mg(A组:79例);人工周期囊胚移植后1 d应用1次GnRH-a 0.1 mg(B组:228例);自然周期囊胚移植后1 d不用GnRH-a 0.1 mg(C组:84例);人工周期囊胚移植后1 d不用GnRH-a 0.1 mg(D组:266例)。【结果】 4组患者年龄、体质量指数(BMI)、基础FSH、内膜厚度以及移植囊胚数量均无统计学差异,4组的临床妊娠率分别为72.15%、 66.23%、 59.52% 及62.78%,自然周期囊胚移植后1 d应用1次GnRH-a 0.1 mg妊娠率明显高于不用GnRH-a 0.1 mg组,并有统计学差异,人工周期囊胚移植后1 d用和不用GnRH-a 0.1 mg对妊娠结局没有影响。【结论】 在移植失败周期≤2次、年龄<40岁、基础FSH<10 U/mL、进行冷冻囊胚移植的优质患者人群,自然周期囊胚移植后1 d应用1次GnRH-a 0.1 mg可明显提高妊娠率,而人工周期无此优势。临床医生应掌握药物使用适应证,为患者高效助孕提供基础。
Abstract: 【Objective】 To discuss the impact on pregnant outcomes of luteal phase support with Gonadotrophin releasing hormone agonist (GnRH -a) in different frozen -thawed cycles (natural cycle/ hormone replace treatment (HRT) cycle) of blastocyst transfer. 【Methods】 Patients underwent first IVF -ET cycle in January 2013 to December 2014, and got their embryos transfer less 2 times, with age below 40 years old, basal FSH below 10 U/L, are involved. The 657 cycles of thawed blastocyst transfer was analyzed, all with at least one good quality blastocysts. All the cycles were divided into 4 groups based on different frozen -thawing cycles and whether use GnRH -a 0.1 mg after 1 day of blastocyst transfer as luteal phase support: natural cycles with GnRH -a as luteal phase support (Group A, n = 79), HRT cycles with GnRH -a as luteal phase support (Group B, n = 228), natural cycles not with GnRH -a as luteal phase suppor (Group C, n = 84) and HRT cycles not with GnRH -a as luteal phase support (Group D, n = 266). The clinical pregnant outcomes were compared among four groups. 【Results】 There were no significantly differences found in age, BMI, basal FSH level, endometrium thickness and number of transferred blastocysts among the four groups. And clinical pregnancy rates were 72.15%, 66.23%, 59.52% and 62.78%, respectively. The pregnancy rates of Group A was higher than Group B and Group C, though there were no significance between the two groups (Group C vs Group D, and Group B vs Group D). Furthermore, The pregnancy rates of Group A compared with Group B, showed significantly higher (P < 0.05). 【Conclusion】 In the cycles of frozen -thawed blastocyst transfer, the pregnancy rate of use GnRH -a 0.1 mg after 1 day of blastocyst transfer as luteal phase support in natural cycles is significantly higher than no use. However, it’s useless in HRT cycles. Maybe the reason is that have luteal or not. Clinical doctors should get hold of indication of using GnRH -a 0.1 mg after 1 day of blastocyst transfer as luteal phase support.
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