论文部分内容阅读
目的:比较两种长效促性腺激素释放激素激动剂（gonadotropin-releasing hormone agonist，GnRH-a）在早卵泡期超长方案中对体外受精/卵胞质内单精子注射（n in vitro fertilization/intracytoplasmic sperm injection，IVF/ICSI）的助孕结局。n 方法:回顾性队列研究分析2019年3月1日至2019年7月31日期间在温州医科大学附属第二医院生殖医学中心采用两种不同GnRH-a在早卵泡期超长方案的患者共802例，根据长效GnRH-a的不同分为醋酸亮丙瑞林组（A组）和曲普瑞林组（B组），比较两组患者的临床和实验室结局。结果:两组患者年龄、不孕年限、体质量指数（body mass index， BMI）、基础性激素水平、不孕类型，促性腺激素（gonadotropin，Gn）启动日性激素水平、Gn使用时间及总量、降调节时间、人绒毛膜促性腺激素（human chorionic gonadotropin，hCG）注射日雌二醇水平及子宫内膜厚度、移植胚胎数、临床结局、治疗总费用，以及因内膜厚度不均、孕酮升高、胚胎质量问题、个体因素而取消移植率等比较，差异均无统计学意义（n P>0.05）。但B组窦卵泡计数（antral follicle count，AFC）（19.59±7.93）、获卵数［（15.39±7.59）枚］、受精数［（11.20±6.53）枚］、卵裂数［（10.85±6.42）枚］、第3日优质胚胎数［（3.01±2.66）枚］、囊胚数［（5.27±4.02）枚］大于A组［17.68±7.23、（13.70±6.94）枚、（9.50±5.43）枚、（9.26±5.34）枚、（2.57±2.33）枚、（4.49±3.40）枚］（n P=0.001n ， P=0.002n ， P<0.001n ， P=0.001n ， P=0.017n ， P=0.007）。A组hCG注射日黄体生成素（luteinizing hormone，LH）［（0.78±0.64）IU/L］、孕酮水平［（0.72±0.39）μg/L］高于B组［（0.55±0.30）IU/L、（0.64±0.36）μg/L］（n P0.05). However, antral follicle count (AFC) (19.59±7.93), the number of retrieved oocytes (15.39±7.59), fertilized oocytes (11.20±6.53), cleaved oocytes (10.85±6.42), good-quality embryos on Day 3 (3.01±2.66), and blastocysts (5.27±4.02) in group B was larger than that in group A (17.68±7.23, 13.70±6.94, 9.50±5.43, 9.26±5.34, 2.57±2.33, 4.49±3.40) (n P=0.001, n P=0.002, n P<0.001,n P=0.001, n P=0.017, n P=0.007). The levels of luteinizing hormone (LH) [(0.78±0.64) IU/L] and progesterone [(0.72±0.39) μg/L] on hCG injection day in group A were higher than those in group B [(0.55±0.30) IU/L, (0.64±0.36) μg/L] (n P<0.001,n P=0.005). The rate of preventing the occurrence of ovarian hyperstimulation syndrome (OHSS) in group A [28.52% (75/263)] was higher than that in group B [14.95% (16/107), n P=0.006].n Conclusion:Two long-acting GnRH-a drugs can achieve satisfactory down-regulation effect, laboratory and clinical outcomes in the long-term early follicular phase. Compared with the triptorelin, leuprolide acetate is relatively mild to pituitary inhibition, with an increasing trend of the clinical pregnancy rate.