卵巢储备功能下降患者减量长效及短效长方案疗效的比较
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国家自然科学基金青年基金(81200410);江苏省临床医学科技专项(BL2014003)


Comparison of low-dose of long-acting and short-acting GnRH agonist (GnRH-a) protocols in the patients with diminished ovarian reserve
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    摘要:

    目的:比较减量长效及短效促性腺激素释放激素激动剂(gonadotrophin releasing hormone analogue,GnRH-a)在卵巢储备功能下降患者中的应用效果。方法:回顾性分析符合卵巢储备功能下降且采用减量长方案的565例体外受精(in vitro fertilization,IVF)/卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)周期,根据使用GnRH-a类型,分为长效组(A组)及短效组(B组)。比较两组基本情况-促排过程-鲜胚及冻胚妊娠结局。结果:与B组相比,A组患者一般情况及助孕方式无显著性差异。A组取卵周期促性腺激素(gonadotripin,Gn)用量及促排天数明显多于B组,两组取卵数及有效胚胎数-鲜胚周期临床妊娠率-流产率及分娩率差异无统计学意义。B组冻胚移植周期临床妊娠率-着床率及分娩率-累计临床妊娠率及分娩率均明显高于A组。结论:对于卵巢储备功能下降的患者仍可以使用减量长方案得到较多的可用胚胎和鲜胚移植机会,其临床妊娠率仍较高。长效GnRH-a增加了Gn用量,且冻胚移植周期妊娠率降低,因而建议这些患者使用减量短效GnRH-a长方案。

    Abstract:

    Objective:To investigate the effects of low-dose of long-and short-acting gonadotrophin releasing hormone analogue(GnRH-a) agonist on patients with diminished ovarian reserve. Methods:Retrospective analysis was performed on 565 in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)cycles,which are consistent with diminished ovarian reserve and using the low-dose long down-deregulation protocol. According to the type of GnRH agonist,they were divided into the long-acting group(group A)and the short-acting group (group B). Then,we compared basic situation,ovulation induction process and outcome of ET and FET cycle of the two groups. Results:There were no significant differences between groups A and B in the general situation and assisted reproductive method. Compared with group B,the egg number and the number of effective embryos of group A had no statistical difference. However,both gonadotripin(Gn)stimulation days and Gn doses were significantly higher in group A compared with group B. In the ET cycle,there was no significant difference in clinical pregnancy rate,abortion rate and delivery rate between group A and B. However,in the FET cycle,the clinical pregnancy rate,implantation rate and delivery rate of group B were significantly higher than those of group A. The cumulative clinical pregnancy rate and delivery rate of group B were also significantly higher than that of group A. Conclusion:Patient with diminished ovarian reserve can still use low-dose long down-deregulation protocol to obtain more effective embryos and fresh embryo transplant opportunity. The clinical pregnancy rates were also high. Long-acting GnRH-a increased the amount of Gn,and the clinical pregnancy rate of this group in FET cycle was lower. This study suggests that these patients use low-dose short-acting GnRH agonist protocol.

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宋天然,孙海翔,王 玢.卵巢储备功能下降患者减量长效及短效长方案疗效的比较[J].南京医科大学学报(自然科学版),2016,(9):1143-1146

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  • 收稿日期:2015-09-26
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  • 在线发布日期: 2016-09-18
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