不同GnRH-a降调节方案用于子宫内膜异位症合并不育者的体外受精-胚胎移植研究

目的比较子宫内膜异位症(EMS)合并不育妇女采用不同促性腺素释放激素激动剂(GnRH-a)降调节方案进行体外受精-胚胎移植(IVF-ET)助孕治疗的结局。方法将2008年1月至2010年12月以超长方案行IVF-ET的各型EMS合并不育患者74例(A组)与同期用长方案患者177例(B组)进行回顾性分析,比较两组患者的助孕结局。结果 A组EMS病情比B组重,促性腺激素(Gn)起始剂量及总量更大,卵泡数、获卵数及获成熟卵数较少,差异有统计学意义(P<0.05)。两组受精率、卵裂率、周期取消率、可移植胚胎数、优质胚胎数及ET胚胎数、流产率、异位妊娠率比较,差异均无统计学意义(P>0.05)。A组可移植胚胎率、优质胚胎率明显高于B组(P<0.05)。A组临床妊娠率、种植率均比B组高,但差异均无统计学意义(P>0.05)。结论超长方案用于EMS患者的IVF-ET助孕有助于改善胚胎质量,且有提高妊娠率及种植率的趋势。

Study on outcome of IVF-ET conducted with different GnRH-a down-regulation protocols on infertility patients with endometriosis

Objective To compare the outcome of in vitro fertilization-embryo transfer(IVF-ET) conducted with different down-regulation protocols on infertile patients with endometriosis.Methods A retrospective analysis was conducted on infertile patients with endometriosis regarding the IVF-ET outcomes in our center from January 2008 to December 2010.The study group included 74 patients applied with prolonged protocol(group A).The control group included 177 patients applied with long protocol in the same time.Results The proportion of severe endometriosis patients in the group A was bigger than that in the group B.Both the initial and the total dose of Gn of the study group were higher than that of the control group.The group A had smaller follicle number,oocyte number and MII oocyte number(P<0.05).There was no obvious difference in the fertilization rate,cleavage rate,cycle cancel rate,transferable embryo number,high quality embryo number,transferred embryo number,abortion rate and ectopic pregnancy rate between the two group s(P>0.05).The transferable embryo rate and high quality embryo rate in the group A were obviously higher than those of the group B(P<0.05).The clinical pregnancy rate and implantation rate in the group A were higher slightly than those of the group B,but there was no statistically significant difference(P>0.05).Conclusion There is improvement of embryo quality and increasing tendency in clinical pregnancy rate and implantation rate using the prolonged protocol than using the long protocol when IVF-ET is conducted on infertility patients with endometriosis.