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目的:探讨长效和短效促性腺激素释放激素激动剂(gonadrotropin releasing hormone agonist,Gn RH-a)在体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)周期长方案中的应用及其对临床结局的影响。方法:回顾性分析267例接受长方案控制性超促排卵(COH)患者的临床资料,根据使用不同剂型的Gn RH-a分为A组和B组,A组142例采用长效Gn RH-a 1.1 mg或0.9 mg单次肌肉注射行垂体降调节,B组125例采用短效Gn RH-a 0.05 mg/d皮下注射至人绒毛膜促性腺激素(h CG)注射日行垂体降调节;分析比较其IVF-ET结局。结果:启动日Gn使用剂量及患者血清黄体生成素(LH)、雌二醇(E2)水平组间比较无统计学差异(P>0.05),A组卵泡刺激素(FSH)水平显著低于B组(P<0.001),但均已达到降调节标准。h CG注射日E2、孕酮(P)水平组间比较无统计学差异(P>0.05),A组LH水平显著低于B组(P<0.001);B组Gn使用时间、总剂量均明显少于A组(P<0.001)。垂体降调节药物使用费用B组显著高于A组(P<0.001),但总药物费用无统计学差异(P>0.05)。获卵数、受精率、卵裂率、优质胚胎率、临床妊娠率、流产率组间均无统计学差异(P>0.05)。结论:在COH过程中,长效和短效Gn RH-a方案均能达到垂体降调节作用,且2种方案的IVF-ET临床结局及患者所承受的经济负担无统计学差异。长效Gn RH-a虽然使用方便,但对垂体的抑制程度更深,在随后的超促排卵过程中Gn的使用时间及使用量均比短效Gn RH-a方案增多。
OBJECTIVE: To investigate the long-term and short-acting gonadotropin releasing hormone agonist (GnRH-a) in long-term regimen of in vitro fertilization and embryo transfer (IVF-ET) And its impact on clinical outcome. Methods: A retrospective analysis of 267 patients receiving long-term controlled ovarian hyperstimulation (COH) in patients with clinical data, according to the use of different formulations of Gn RH-a divided into groups A and B, 142 cases of group A using long-acting Gn RH- a 1.1 mg or 0.9 mg single intramuscular injection of pituitary down regulation, 125 cases of group B using short-acting Gn RH-a 0.05 mg / d subcutaneous injection of human chorionic gonadotropin (hCG) injection day hypopituitarism; Analysis and comparison of its IVF-ET outcome. Results: There was no significant difference in the dosage of Gn on start-up day and the levels of serum LH and E2 between the two groups (P> 0.05). The level of follicle stimulating hormone (FSH) in group A was significantly lower than that of B Group (P <0.001), but all had reached the standard of down regulation. (P> 0.05). The LH level in group A was significantly lower than that in group B (P <0.001). The time of Gn administration in group B was significantly higher than that in group B Less than in group A (P <0.001). Pituitary-lowering drug use costs in group B were significantly higher than those in group A (P <0.001), but the total drug cost was not statistically different (P> 0.05). Oviposition, fertilization rate, cleavage rate, high quality embryo rate, clinical pregnancy rate and miscarriage rate had no significant difference (P> 0.05). CONCLUSION: Both long-term and short-term GnRH-a regimens can achieve hypopituitarism during COH. There is no significant difference between the two regimens in IVF-ET clinical outcomes and the patients’ economic burden. Although long-acting Gn RH-a is easy to use, it inhibits the pituitary more deeply, and the use time and the amount of Gn in the subsequent superovulation are both increased compared with the short-acting Gn RH-a.