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不同剂量曲普瑞林降调节方案用于体外受精-胚胎移植的临床效果
单丹,赵军招,吕杰强,应映芬,张帆
作者单位
单丹 温州医科大学附属第二医院生殖医学中心 
赵军招  
吕杰强  
应映芬  
张帆  
摘要:
目的探讨在体外受精-胚胎移植(IVF-ET)中不同剂量曲普瑞林降调节效果,探索最佳注射剂量,以寻找性价比最高的治疗方案。方法回顾性分析行黄体期长方案治疗的379个IVF-ET周期,采用不同剂量曲普瑞林降调节(0.60~1.00mg117例为A组,1.75~2.00mg65例为B组,3.75mg197例为C组),比较3组患者降调节后启动日、注射绒毛膜促性腺激素(HCG)日雌激素水平,子宫内膜厚度,促性腺激素(Gn)使用时间及总量,获卵数、成熟卵子率、正常受精率、卵裂率、第3天优胚率,种植率、临床妊娠率、流产率、重度卵巢过度刺激综合征(OHSS)发生率等。结果降调节后启动日C组促黄体生成素(LH)水平为(0.41±0.28)IU/L,分别低于A组(1.32±0.60)IU/L和B组(1.17±0.51)IU/L(均P<0.05);注射HCG日A组LH水平为(0.98±1.09)IU/L,分别高于B组(0.57±0.30)IU/L和C组(0.62±0.60)IU/L(均P<0.05);Gn使用天数为B组>C组>A组(均P<0.05);Gn使用总量3组比较差异无统计学意义(P>0.05)。B、C组成熟卵子率均高于A组(均P<0.05);B组第3天优胚率明显高于A组(P<0.05),与C组比较差异无统计学意义(P>0.05)。3组患者获卵数、正常受精率、卵裂率、种植率、临床妊娠率、流产率、重度OHSS发生率比较,差异均无统计学意义(均P>0.05)。结论全量曲普瑞林降调节在不增加Gn用量的前提下,种植率、临床妊娠率均良好,流产率、重度OHSS发生率均较低,是一种安全有效的降调节方法。
关键词:  降调节 促性腺激素释放激素激动剂 子宫内膜容受性 体外受精 - 胚胎移植
DOI:10.12056/j.issn.1006-2785.2017.39.15.2017-744
分类号:
基金项目:
Optimal dosage of triptorelin for downregulation in in vitro fertilization-embryo transfer
SHAN Dan,ZHAO Junzhao,LV Jieqinag,YING Yingfen,ZHANG Fan
Abstract:
Objective To analysis of downregulating effect of different dosage of triptorelin (GnRHa), in vitro fertilization - embryo transfer (IVF-ET), to explore the best triptorelin injection dosage, looking for the best treatment for infertile patients. Methods A retrospective analysis of 379 IVF-ET cycle using luteal phase long acting, Divided them into three groups according to dose of GnRHa, GnRHa 0.6-1.0mg for group A (n=117), GnRHa 1.75-2.0mg for group B (n=65), GnRHa3.75mg for group C (n=197), compare the hormone level after downregulated and on day of HCG administration,Gn days and Gn dosage, oocyte numbers, laboratory data, implantation rate, pregnancy rate, abortion rate and the incidence of severe ovarian hyperstimulation syndrome. Results The LH level after downregulation (0.41±0.28)IU/L in group C was lower than that in group A (1.32 ±0.60) IU/L and group B (1.17±0.51)IU/L(P<0.05). LH level on the day of hCG administration in group A(0.98±1.09)IU/L is significantly higher than that in group B (0.57±0.30)IU/L and group C (0.62±0.60)IU/L (P<0.05). Gn using days in group B turned longest, longer than group C and group A , comparing one to each other statistically significant (P<0.05), but the dosage of the Gn using have no statistical difference in three groups.Oocytes mature rate in group B and C was obviously higher than that of group A. Optimal embryo rate in group B was obviously higher than that in group A, while there was no significant difference compare to group C.There were no significant difference in oocyte numbers,normal fertilization rate, cleavage rate,implantation rate,clinical pregnancy rate,abortion rate and severe OHSS rate in three groups (P >0.05). Conclusion Downregulation with full dose of Gn- RHa without increasing Gn usage turned out a fine outcome in implantation rate and clinical pregnancy rate, a lower abortion rate and less incidence of severe OHSS. It is a safe and effective method of downregulation.
Key words:  Downregulation Gonadotropin-releasing hormone agonist The receptivity of endometrium In vitro fertilization and embryo transplantation