低剂量长效促性腺激素释放激素激动剂在体外受精-胚胎移植中的应用

目的: 探讨体外受精－胚胎移植(IVF-ET)中长效促性腺激素释放激素激动剂(GnRH-a)降调节的最低有效剂量。方法: 回顾性分析2009年至2010年行体外受精(IVF)/单精子卵胞浆内注射(ICSI)治疗的长方案周期,根据黄体中期注射GnRH-a剂量分<0.6 mg(A组),≥0.6 mg<0.8 mg(B组),≥0.8 mg(C组),每组随机抽取100个周期,比较治疗效果。结果: 三组的移植周期数分别为92个,80个及85个。三组成熟率、受精率、优质胚胎率、自然流产率及宫外孕率差异均无统计学意义(P>0.05)。A组种植率(37.91%)及每移植周期妊娠率(63.04%)均明显高于B组(25.14%及37.5%)和C组(23.16%及 41.18%) (P<0.01),B组和C组相比差异无统计学意义(P>0.05)。C组Gn用量显著高于A组和B组(P<0.01),而启动日LH值及hCG日LH值均明显低于A组和B组(P<0.05)。结论: 使用极低剂量GnRH-a能获得很好的临床结局。

Clinical application of low-dose of long-acting Gonadotropin-release hormone agonist(GnRH-a) in vitro fertilization-embryo transfer

AIM: To investigate the suboptimal dose of long-acting GnRH-a used for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).METHODS: Retrospective evaluation of long protocols for those patients undergoing IVF/ICSI from 2009 to 2010. Due to the dose of GnRH-a used in luteal metaphase, they were divided into three groups: <0.6 mg(Group A), ≥0.6 mg<0.8 mg(Group B),≥0.8 mg(Group C), in which randomly extract 100 cycles in each group. The clinical outcomes were observed.RESULTS: The transfer cycles of Group A, B, C were 92, 80, 85, respectively. In three groups, there were no significant differences in the rates of maturation, fertilization, high quality embryo, abortion and ectopic pregnancy(P>0.05). The plantation rate and clinical pregnancy rate per transfer were also higher in group A than thore group B and C(37.91% vs25.14% vs 23.16%, 63.04% vs 37.5% vs 41.18%, respectively, P<0.01). In group C, the total Gn amount was significantly larger (P<0.01), and the level of LH on Gn day and hCG day were both lower(P<0.05), compared with the other two groups.CONCLUSION: Long-actiong GnRH-a in very low dose could get perfect clinical outcome.