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目的:初步探讨控制性超促排卵(COH)过程中如何避免卵泡提前黄素化(premature luteinization,PL),提高IVF-ET妊娠率。方法:回顾性分析行GnRH-a黄体中期长方案的IVF-ET治疗患者的临床资料,共2 355个周期,根据hCG注射日孕酮(P)/雌二醇(E2)水平的比值是否>1分为PL组:即卵泡提前黄素化组,P/E2≥1,共63个周期;非PL组:即卵泡未提前黄素化组,P/E2<1,共2 292个周期。比较患者的一般资料及COH的参数资料,分析可能与PL相关的因素。结果:PL在GnRH-a长方案IVF-ET患者中的发生率为2.68%。女方年龄、男方年龄、女方体质量指数(BMI)、基础E2(bE2)、bLH、bFSH、不孕年限、治疗周期数、Gn启用剂量、hMG使用总量、hMG使用总天数、hCG注射日LH值组间差异无统计学意义(P>0.05)。PL组的Gn使用总量及Gn使用天数比非PL组的高,差异有统计学意义(P<0.05)。PL组的hCG注射日直径>15 mm卵泡数及MII卵数比非PL组的少,差异有统计学意义(P<0.05)。结论:PL在行GnRH-a长方案的IVF-ET治疗患者中的发生率为2.68%。Gn的使用天数,Gn总量过多,卵巢低反应可能是发生PL的相关因素,为避免发生PL可适当减少Gn的使用天数及Gn使用总量。
Objective: To investigate how to avoid premature luteinization (PL) and increase the pregnancy rate of IVF-ET during controlled ovarian hyperstimulation (COH). Methods: A retrospective analysis of long-term GnRH-a corpus luteum long-term treatment of patients with IVF-ET clinical data, a total of 2 355 cycles, according to the hCG injection of progesterone (P) / estradiol (E2) 1 was divided into PL group: the follicular premature luteinization group, P / E2≥1, a total of 63 cycles; non-PL group: follicles without pre-luteinization group, P / E2 <1, a total of 2 292 cycles. Comparing the general data of patients and the parameters of COH, we analyzed the factors that may be related to PL. Results: The incidence of PL in GnRH-a long-term IVF-ET patients was 2.68%. Female age, male age, female body mass index (BMI), basal E2 (bE2), bLH, bFSH, duration of infertility, number of cycles of treatment, Gn-enabled dose, total hMG use, total hMG use days, There was no significant difference between value groups (P> 0.05). The total amount of Gn use and the number of days of Gn use in PL group were significantly higher than those in non-PL group (P <0.05). At the day of hCG injection, the number of follicles and MII oocytes with a diameter> 15 mm in PL group were less than those in non-PL group on the day of injection, and the difference was statistically significant (P <0.05). Conclusions: The incidence of PL was 2.68% in IVF-ET-treated patients who underwent GnRH-a long protocol. Gn use of the number of days, Gn total excessive ovarian response may be the occurrence of PL related factors, in order to avoid the occurrence of PL may be appropriate to reduce the use of Gn days and the total amount of Gn use.