GnRH—a长方案与改良短方案对IVF—ET妊娠结局的影响

目的]探讨促性腺激素释放激素激动剂（GnRH-a）长方案与改良短方案控制性促排卵（COH）对体外受精-胚胎移植（IVF-ET）妊娠结局的影响.方法]回顾性分析因单纯输卵管因素首次接受体外受精的取卵周期648例临床资料,其中长方案组390例,改良短方案组258例.比较两组促排卵后激素水平、子宫内膜厚度、促性腺激素（Gn）使用剂量、COH天数、取卵数及妊娠结局.结果]两组注射绒促性素当天（HCG日）雌、孕激素水平、卵子受精率、卵裂率、优胚率、移植胚胎个数比较差异无显著性（P〉0.05）,长方案组在Gn使用量、COH天数、取卵数、HCG日子宫内膜厚度及胚胎种植率、临床妊娠率均高于改良短方案组（P〈0.01）,而HCG日LH水平低于改良短方案组（P〈0.01）.结论]在控制性促排卵中长方案获卵数、胚胎种植率及临床妊娠率较改良短方案高,可作为单纯输卵管因素不孕患者IVF-ET治疗的首选促排卵方案.

Effect of Long and Improved Short Protocol with GnRH-a on Pregnancy Outcome in vitro Fertilization

Objective] To compare the pregnancy outcome of long and improved short protocol with gonadotropin-releasing hormone agonist（GnRH-a） in patients undergoing in vitro fertilization-embryo transfer（IVF- ET）. Methods] The clinical data of 648 patients with fallopian tube obstruction who underwent in vitro fertilization at the first time, including 390 cases of long protocol and 258 cases of improved short protocol, were analyzed retrospectively. The serum hormone levels after COH, endometrial thickness, gonadotropin doses, days of COH, number of retrieved oocytes and the outcome of IVF-ET were compared. Results] There were no statistical difference in the serum estradial（E2） and progestogen（P） levels on HCG day, fertilization rate, cleaved rate, high embryos rate and embryos transfer （ P 〉0.05）. The doses of Gn, days of COH, numbers of ooeytes retrieved, endometrial thickness on the day of injection of HCG, implantation rate and pregnancy rate and clinical pregnancy rate were higher in long protocol group than improved short protocol group（ P〈0. 01）. The serum luteotrophic hormone（LH） level was lower in the long protocol group than that in the improved short protocol group （ P〈0.01）. ConelusionlThe number of ooeytes retrieved, implantation rate and clinical pregnancy rate in the long protocol with GnRH a are higher than those in the improved short protocol with GnRH-a, so the long protocol with GnRH-a can be the first choice of COH protocol for patients with obstructed fallopian tube undergoing IVF-ET.