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目的 :比较减量长效及短效促性腺激素释放激素激动剂(gonadotrophin releasing hormone analogue,GnRH-a)在卵巢储备功能下降患者中的应用效果。方法:回顾性分析符合卵巢储备功能下降且采用减量长方案的565例体外受精(in vitro fertilization,IVF)/卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)周期,根据使用GnRH-a类型,分为长效组(A组)及短效组(B组)。比较两组基本情况、促排过程、鲜胚及冻胚妊娠结局。结果:与B组相比,A组患者一般情况及助孕方式无显著性差异。A组取卵周期促性腺激素(gonadotripin,Gn)用量及促排天数明显多于B组,两组取卵数及有效胚胎数、鲜胚周期临床妊娠率、流产率及分娩率差异无统计学意义。B组冻胚移植周期临床妊娠率、着床率及分娩率、累计临床妊娠率及分娩率均明显高于A组。结论 :对于卵巢储备功能下降的患者仍可以使用减量长方案得到较多的可用胚胎和鲜胚移植机会,其临床妊娠率仍较高。长效GnRH-a增加了Gn用量,且冻胚移植周期妊娠率降低,因而建议这些患者使用减量短效GnRH-a长方案。
OBJECTIVE: To compare the efficacy of reduced-dose and long-acting gonadotrophin releasing hormone analogue (GnRH-a) in patients with decreased ovarian reserve. Methods: A total of 565 in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) cycles with reduced ovarian reserve function were retrospectively analyzed. According to GnRH-a Type, divided into long-acting group (A group) and short-acting group (B group). Comparison of two groups of basic conditions, promoting process, fresh embryos and frozen embryos pregnancy outcome. Results: Compared with group B, there was no significant difference in the general situation and method of pregnancy between group A and group B. The amount of gonadotripin (Gn) in ovariectomized group and the number of days for promoting ovulation were significantly higher in group A than those in group B. The number of fetuses and the number of effective embryos in two groups did not show significant difference in clinical pregnancy rate, miscarriage rate and delivery rate significance. The clinical pregnancy rate, implantation rate and delivery rate, cumulative clinical pregnancy rate and delivery rate in group B were significantly higher than those in group A during the cycle of frozen embryo transfer. CONCLUSIONS: There is still a greater chance of available embryo and fresh embryo transfer with reduced-length regimens for patients with decreased ovarian reserve, and their clinical pregnancy rates are still high. Long-acting GnRH-a increased the amount of Gn, and decreased the pregnancy rate of frozen-embryo transfer cycles, suggesting that these patients should be given a short-acting GnRH-a regimen.