长效和短效GnRH-a在IVF/ICSI周期长方案中慢反应发生率及临床结局的比较

Comparison of suboptimal response and clinical outcome of long- and short-acting GnRH-agonist in IVF/ICSI

摘要:

目的  比较长效和短效促性腺激素释放激素激动剂GnRH-a在体外受精（IVF）或卵泡浆内单精子注射（ICSI）新鲜移植周期长方案中慢反应发生率及临床结局。方法  回顾性分析2013年4月-2014年11月该院生殖中心606个长方案IVF/ICSI新鲜移植周期的临床资料，对排卵正常者采用黄体中期降调长方案，无规律排卵者行口服避孕药预处理长方案，根据采用不同的剂型分为两组：A组长效GnRH-a组，B组短效GnRH-a组，比较两组的临床结局。结果  两组平均促性腺激素（Gn）时间、平均获卵数、受精率、卵裂率及优质胚胎率比较，差异无统计学意义（P >0.05）；平均Gn总量A组（2 235.27±1 521.61）IU，B组（2 063.29±677.50）IU，A组高于B组（P = 0.043）；发生慢反应率A组8.06%（35），B组1.73%（3），A组高于B组（P =0.021）；临床妊娠率A组50.33%（152/302），B组40.94%（52/127），A组高于B组（P =0.015）；种植率A组33.45%，B组27.98%，A组高于B组（P =0.033）。结论  相比较于短效长方案，长效长方案平均Gn总量增加，发生慢反应概率增加，但临床妊娠率、种植率增加；对于卵巢储备功能正常者，在促排卵过程中若能有效处理好慢反应，选择长效长方案，可以获得更好的临床结局。

Abstract:

Objective To investigate the suboptimal response and clinical outcomes of long- and short-acting gonadotropin-releasing hormone agonist (GnRH-a) in fresh transfer cycles of in vitro fertilization-embryo transfer and intracytoplasmic sperm injection (IVF/ICSI) with long protocol. Methods Six hundred and six IVF/ICSI fresh transfer cycles with long protocol in our hospital from April 2013 to November 2014 were recruited in this study. The women were 35 years old or younger. The patients with normal ovulation accepted pituitary desensitization during long protocol at mid-luteal phase, whlie the patients with ovulation failure underwent oral contraceptives (OC) pretreatment. Group A consisted of cycles with long-acting GnRH-a down-regulation, while group B consisted of cycles with short-acting GnRH-a down-regulation. Results The mean gonadotropin (Gn) stimulation days, the number of retrieved oocytes, fertilization rate, cleavage rate and high-quality embryo rate were not significantly different between the two groups (P > 0.05). However, there were significant differences in the average total Gn doses [(2235.27 ± 1521.61) IU vs (2063.29 ± 677.50) IU], slow reaction rate (8.06% vs 1.73%), clinical pregnancy rate (50.33% vs 40.94%) and implantation rate (33.45% vs 27.98%) between the groups A and B (P < 0.05). Conclusions The long-acting GnRH-a protocol results in higher clinical pregnancy and implantation rates, however, increases the total amount of Gn and the probability of occurrence of slow reaction compared to the short-acting GnRH-a protocol. Patients with normal ovarian reserve could have a better clinical outcome if slow reaction is effectively treated in long-acting GnRH-a long protocol.