1st Department of Obstetrics and Gynaecology, Semmelweis University Faculty of Medicine, Budapest, Hungary.
Reprod Biol Endocrinol. 2009 Sep 25;7:103. doi: 10.1186/1477-7827-7-103.
Despite the clinical outcomes of ovarian stimulation with either GnRH-agonist or GnRH-antagonist analogues for in vitro fertilization (IVF) being well analysed, the effect of analogues on oocyte/embryo quality and embryo development is still not known in detail. The aim of this case-control study was to compare the efficacy of a multiple-dose GnRH antagonist protocol with that of the GnRH agonist long protocol with a view to oocyte and embryo quality, embryo development and IVF treatment outcome.
Between October 2001 and December 2008, 100 patients were stimulated with human menopausal gonadotrophin (HMG) and GnRH antagonist in their first treatment cycle for IVF or intracytoplasmic sperm injection (ICSI). One hundred combined GnRH agonist + HMG (long protocol) cycles were matched to the GnRH antagonist + HMG cycles by age, BMI, baseline FSH levels and by cause of infertility. We determined the number and quality of retrieved oocytes, the rate of early-cleavage embryos, the morphology and development of embryos, as well as clinical pregnancy rates. Statistical analysis was performed using Wilcoxon's matched pairs rank sum test and McNemar's chi-square test. P < 0.05 was considered statistically significant.
The rate of cytoplasmic abnormalities in retrieved oocytes was significantly higher with the use of GnRH antagonist than in GnRH agonist cycles (62.1% vs. 49.9%; P < 0.01). We observed lower rate of zygotes showing normal pronuclear morphology (49.3% vs. 58.0%; P < 0.01), and higher cell-number of preembryos on day 2 after fertilization (4.28 vs. 4.03; P < 0.01) with the use of GnRH antagonist analogues. The rate of mature oocytes, rate of presence of multinucleated blastomers, amount of fragmentation in embryos and rate of early-cleaved embryos was similar in the two groups. Clinical pregnancy rate per embryo transfer was lower in the antagonist group than in the agonist group (30.8% vs. 40.4%) although this difference did not reach statistical significance (P = 0.17).
Antagonist seemed to influence favourably some parameters of early embryo development dynamics, while other morphological parameters seemed not to be altered according to GnRH analogue used for ovarian stimulation in IVF cycles.
尽管 GnRH 激动剂或 GnRH 拮抗剂类似物在体外受精（IVF）中的临床结局已得到很好的分析，但类似物对卵母细胞/胚胎质量和胚胎发育的影响仍不清楚。本病例对照研究的目的是比较多剂量 GnRH 拮抗剂方案与 GnRH 激动剂长方案的疗效，以期比较卵母细胞和胚胎质量、胚胎发育和 IVF 治疗结局。
2001 年 10 月至 2008 年 12 月，100 例患者在其 IVF 或胞浆内单精子注射（ICSI）的第一个治疗周期中接受人绝经期促性腺激素（HMG）和 GnRH 拮抗剂刺激。100 个联合 GnRH 激动剂+HMG（长方案）周期通过年龄、BMI、基础 FSH 水平和不孕原因与 GnRH 拮抗剂+HMG 周期相匹配。我们确定了获得的卵母细胞数量和质量、早期卵裂胚胎率、胚胎形态和发育以及临床妊娠率。使用 Wilcoxon 配对秩和检验和 McNemar 卡方检验进行统计分析。P<0.05 被认为具有统计学意义。
使用 GnRH 拮抗剂时，获得的卵母细胞细胞质异常率明显高于 GnRH 激动剂组（62.1% vs. 49.9%；P<0.01）。我们观察到正常核形态的受精卵率较低（49.3% vs. 58.0%；P<0.01），受精后第 2 天的胚胎细胞数较高（4.28 vs. 4.03；P<0.01）。两组之间成熟卵母细胞率、多核胚泡存在率、胚胎碎片率和早期卵裂胚胎率相似。拮抗剂组胚胎移植的临床妊娠率低于激动剂组（30.8% vs. 40.4%），尽管差异无统计学意义（P=0.17）。
拮抗剂似乎有利于影响早期胚胎发育动力学的一些参数，而其他形态学参数似乎不受用于 IVF 周期卵巢刺激的 GnRH 类似物的影响。
