不同降调节长方案GnRH-a剂量与LH水平的关系及临床结局的比较
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摘要
【目的】观察不同剂量促性腺激素释放激素激动剂(GnRH-a)降调节长方案黄体生成素(LH)水平在超促排卵过程中的动态变化,探讨GnRH-a用量与超排卵过程中LH水平的关系,同时比较各方案的妊娠结局。【方法】回顾性分析2015年1月至2015年6月中山大学附属第一医院生殖中心采用1.0、0.8、0.375 mg长效长方案及0.1、0.05 mg/d短效长方案降调节的周期共250例,每组50例,比较分析黄体期使用不同剂量GnRH-a后在开始促排卵当天(Gn0)、促排卵第4天(Gn4)、促排卵第7天(Gn7)及注射HCG日(HCG日)的LH水平在不同方案之间的差异,比较各组获卵数、正常受精率、优质胚胎率、囊胚移植率、移植胚胎数、种植率及临床妊娠率。【结果】长效长方案中,0.375 mg组在超排卵过程中各时间点的LH水平均高于1.0及0.8 mg组(P<0.05);1.0、0.8 mg组的Gn使用时间、总Gn用量及HMG用量明显大于0.375 mg组,差异均具统计学意义(P<0.05);LH水平越高,胚胎种植率有增加的趋势,无统计学差异(P>0.05);短效长方案中,0.1 mg/d组超排卵过程各时间点的LH水平高于0.05 mg/d组,在Gn0、Gn7及HCG日差异均具统计学意义(P<0.05);Gn使用时间、总Gn用量及HMG用量在两组间无统计学差异(P>0.05)。0.1 mg/d组比0.05 mg/d组胚胎种植率高,无统计学差异(P>0.05)。【结论】长效长方案中,超排卵过程中的LH水平及胚胎种植率随着GnRH-a用量的减少而升高;短效长方案中,0.1 mg/d组的LH水平和胚胎种植率较0.05 mg/d组高。
【Objective】To observe the dynamic changes of serumLH levels in different GnRH-along protocols,and investigate the relationship between GnRH-adosage and LH levels,and compare the clinical outcomes among different GnRH-a long protocols.【Methods】In this retrospective study,1.0 mg,0.8 mg,0.375 mg long-acting and 0.1 mg/d,0.05 mg/d short-acting GnRH-a long protocols were included from January to June in 2015 at the Reproductive Medicine Center of the First Affiliated Hospital of Sun YatSen University.SerumLH levels were evaluated from a total of 250 women at the four time points,on the day before gonadotropin stimulation(Gn0),the fourth day of Gn stimulation(Gn4),the seventh day of Gn stimulation(Gn7),and the HCG administration day(HCG day),then the relationship between serumLH levels and the dosage of GnRH-a were analyzed.The number of oocytes retrieved,fertilization rate,good quality embryos rate,blastocyst transferred rate,the number of transferred embryos,implantation rate and clinical pregnancy rate were also compared.【Results】Among the long-acting groups,LH levels in 0.375 mg group were higher than those in 1.0 mg and 0.8 mg groups at the four time points(P<0.05).Total Gn dose,duration of Gnstimualtion and HMG dosage of 1.0 mg protocol and 0.8 mg protocol were significantly higher than those of 0.375 mg group(P<0.05).In addition,the implantation rate showed an increasing tendency when the level of LH increases(P > 0.05).In short-acting groups,the LH levels in0.05 mg/d protocol were significantly lower than those in the 0.1 mg/d group at Gn0,Gn7 and HCG day(P<0.05).Total Gn dose,duration of Gn stimulation and HMG dosage did not show significant difference between 0.05 mg and 0.1mg group.What′s more,the implantation rate in 0.1 mg/d group was higher than in 0.05 mg/d group(P > 0.05).【Conclusion】Among the long-acting groups,the smaller amount of GnRH-a was administrated,the higher LH levels during ovarian stimulation and implantation rate the patients obtained.As to the short-acting groups,the LH level and implantation rate in 0.1 mg/d group is higher than those in 0.05 mg/d group.
【Objective】To observe the dynamic changes of serumLH levels in different GnRH-along protocols,and investigate the relationship between GnRH-adosage and LH levels,and compare the clinical outcomes among different GnRH-a long protocols.【Methods】In this retrospective study,1.0 mg,0.8 mg,0.375 mg long-acting and 0.1 mg/d,0.05 mg/d short-acting GnRH-a long protocols were included from January to June in 2015 at the Reproductive Medicine Center of the First Affiliated Hospital of Sun YatSen University.SerumLH levels were evaluated from a total of 250 women at the four time points,on the day before gonadotropin stimulation(Gn0),the fourth day of Gn stimulation(Gn4),the seventh day of Gn stimulation(Gn7),and the HCG administration day(HCG day),then the relationship between serumLH levels and the dosage of GnRH-a were analyzed.The number of oocytes retrieved,fertilization rate,good quality embryos rate,blastocyst transferred rate,the number of transferred embryos,implantation rate and clinical pregnancy rate were also compared.【Results】Among the long-acting groups,LH levels in 0.375 mg group were higher than those in 1.0 mg and 0.8 mg groups at the four time points(P<0.05).Total Gn dose,duration of Gnstimualtion and HMG dosage of 1.0 mg protocol and 0.8 mg protocol were significantly higher than those of 0.375 mg group(P<0.05).In addition,the implantation rate showed an increasing tendency when the level of LH increases(P > 0.05).In short-acting groups,the LH levels in0.05 mg/d protocol were significantly lower than those in the 0.1 mg/d group at Gn0,Gn7 and HCG day(P<0.05).Total Gn dose,duration of Gn stimulation and HMG dosage did not show significant difference between 0.05 mg and 0.1mg group.What′s more,the implantation rate in 0.1 mg/d group was higher than in 0.05 mg/d group(P > 0.05).【Conclusion】Among the long-acting groups,the smaller amount of GnRH-a was administrated,the higher LH levels during ovarian stimulation and implantation rate the patients obtained.As to the short-acting groups,the LH level and implantation rate in 0.1 mg/d group is higher than those in 0.05 mg/d group.
引文
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[12]李洁,刘倍余.识别促性腺激素释放激素激动剂对垂体卵巢轴降调节抑制程度及意义[J].生殖医学杂志,2011,20(s):17-19.
[13]Takahashi K1,Karino K,Kanasaki H,et al.Altered kinetics of pituitary response to gonadotropin-releasing hormone in women with variant luteinizing hormone:correlation with ovulatory disorders[J].Horm Res,2004,61(1):27-32.
[14]Ren J,Sha A,Han D,et al.Does prolonged pituitary down-regulation withgonadotropin-releasing hormoneagonist improve the live-birth rate in vitro fertilization treatment?[J].Fertil Steril,2014,102(1):75-81.
[15]Groenewoud ER,Cantineau AE,Kollen BJ,et al.What the optimal means of preparing the endometrium in frozen-thawed embryo transfer cycles?A systematic review and meta-analysis[J].Hum Reprod Update,2017,23(2):255-261.
[2]粟妤,黄筱金.长效和短效达菲林对垂体降调节的作用及对体外受精—胚胎移植结局的影响[J].实用临床医学,2010,11(6):5-8.
[3]倪亚莉.不同剂量Gn RHa降调节对体外受精/卵泡浆内单精子显微注射降调结果的观察[J].中国优生优育,2009,15(5):265-267.
[4]李洁,谭真,任姿,等.可控制性卵巢刺激治疗中促性腺激素释放激素激动剂降调节与卵巢过度抑制[J].生殖医学杂志,2007,16(5):306-308.
[5]Prato BD,Borini A,Trevisi MR,et al.Effect of reduced does of triptorelin at the start of ovarian stimulation on the outcome of IVF:a randomized study[J].Hum Reprod,2001,16(7):1409-1414.
[6]Janssens RMJ,Vermeiden JPW,Lambalk CB,et al.Gonadotrophin-releasing hormone agonist dose-dependency of pituitary desensitization during controlled ovarian hyperstimulation in IVF[J].Hum Reprod,1998,13(9):2386-2391.
[7]Yin SF,Lok IH.Dose-finding study for the use of longacting gonadotrophin-releasing hormone analogues prior to ovarian stimulation for IVF[J].Hum Reprod,2001,16(3):492-494.
[8]李洁,周灿权,钟依平,等.不同小剂量促性腺激素释放激素激动剂在体外受精-胚胎移植中应用的比较[J].中华妇产科杂志,2006,41(4):269-270.
[9]黄睿,李婷婷.不同剂量促性腺激素释放激素激动剂长方案中黄体生成素水平变化及临床意义[J].生殖医学杂志,2013,22(10):736-738.
[10]Mohamed KA1,Davies WA,Lashen H.Dynamics of pituitary down-regulation and ovarian response to controlled stimulation in in vitro fertilization cycles[J].Fert Ster,2007,87(2):433-435.
[11]Broekmans FJ,Hompes PG,Lambalk CB,et al.Short term pituitary desensitization:effects of different doses of the gonadotrophin-releasing hormone agonist triptorelin[J].Human Reprod,1996,11(1):55-60.
[12]李洁,刘倍余.识别促性腺激素释放激素激动剂对垂体卵巢轴降调节抑制程度及意义[J].生殖医学杂志,2011,20(s):17-19.
[13]Takahashi K1,Karino K,Kanasaki H,et al.Altered kinetics of pituitary response to gonadotropin-releasing hormone in women with variant luteinizing hormone:correlation with ovulatory disorders[J].Horm Res,2004,61(1):27-32.
[14]Ren J,Sha A,Han D,et al.Does prolonged pituitary down-regulation withgonadotropin-releasing hormoneagonist improve the live-birth rate in vitro fertilization treatment?[J].Fertil Steril,2014,102(1):75-81.
[15]Groenewoud ER,Cantineau AE,Kollen BJ,et al.What the optimal means of preparing the endometrium in frozen-thawed embryo transfer cycles?A systematic review and meta-analysis[J].Hum Reprod Update,2017,23(2):255-261.