长方案中短效促性腺激素释放激素激动剂使用时间对临床结局的影响

目的 探讨短效曲普瑞林长方案中不同卵泡大小停用促性腺激素释放激素激动剂（GnRH-a）方案的临床效果。 方法 回顾性分析2012年11月－2013年1月期间，行体外受精/卵胞浆单精子注射助孕，年龄＜40岁妇女，排除卵巢储备功能低下、多囊卵巢综合征以及既往有卵巢手术和卵巢反应不良史者，共收集358个周期的临床资料，根据停用GnRH-a时主导卵泡大小分为＜14 mm和≥14 mm两组。 结果 早期停用GnRH-a组患者控制性促排卵（COH）中促性腺激素用量及使用时间高于晚期停用GnRH-a组（P＜0.05）；但两组患者HCG日雌二醇、孕酮、早发孕酮峰发生率及获卵数、优胚数、胚胎种植率、临床妊娠率、早期流产率和活产率等临床结局差异无统计学意义（P＞0.05）。 结论 对于接受短效GnRH-a长方案患者，COH过程中表现为卵巢慢反应者早期停用GnRH-a可有效维持垂体降调节，且不影响临床妊娠结局。

Effect of the Using Time of Different Gonadotropin-releasing Hormone Agonist on Clinical Outcomes during Controlled Ovarian Stimulation

Objective To compare the clinical outcomes of different pituitary down regulation protocols with gonadotropin-releasing hormone agonist （GnRH-a） in patients undergoing in vitro fertilization and embryo transfer （IVF-ET） treatment. Methods The clinical data of 358 IVF cycles in women at 40 years old or younger from November 2012 to January 2013 in the West China Second University Hospital were analyzed retrospicctively. All the 358 cycles were divided into two groups, according to whether the leading follicle diameter was 〈 14 mm （group A, 158 cycles） or I〉 14 mm （group B, 200 cycles） after discontinuing the GnRH-a. The clinical outcomes were compared between the two groups. Results Compared with group B, the amount of gonadotropins used was significantly more, and the time of gonadotropin use was also significantly longer in group A （P 〈 0.05）. However, the serum level of estradiol （E2）, progesterone （P） and Luteinizing hormone （LH）, incidence of premature P rise, retrieved ovum number, the rates of implantation, clinical pregnancy, miscarriage and live birth did not significantly differ between the two groups （P 〉 0.05）. Conclusion Discontinuing the use of GnRH-a in early stage of controllicd ovarian stimulation same optimal clinical outcomes in patients undergoing IVF-ET. can keep effective pituitary down regulation and it has the