Wang Li, Zhang Wen-xiang, Jiang Hong
Reproductive Medical Center, Clinical College of People's Liberation Army, Anhui Medical University, Hefei 230031, China.
Zhonghua Fu Chan Ke Za Zhi. 2012 Dec;47(12):910-4.
To evaluate the clinical effect of different doses of leuprorelin acetate in in vitro fertilization-embryo transfer (IVF-ET).
From January 2011 to December 2011, the data of 268 patients undergoing IVF and(or) intracytoplasmic sperm injection (ICSI) in Reproductive Medical Center, Clinical College of PLA, Anhui Medical University were studied retrospectively. All the patients were divided into three groups based on with long protocol and controlled ovarian stimulation (COH) including 83 cycles with 1.25 mg of leuprorelin in low dose group, 68 cycles with 1.88 mg of leuprorelin in high dose group, 117 cycles with 1.25 mg of diphereline in control group. The serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E(2)) and progesterone (P) before gonadotropin (Gn) administration on the days 3-5 of the menstrual cycle and on the day of hCG administration were detected, the dose and duration of Gn, number of oocytes retrieved, number of mature oocytes, the rates of fertilization, embryo cleaved, good-quality embryos clinical pregnancy and early miscarriage were compared among three groups.
There were no significant differences in age, the level of LH and P on the day of hCG administration among three groups (P > 0.05). The level of FSH was (3.8 ± 1.6) U/L in low dose leuprorelin group, (3.1 ± 1.4) U/L in high dose of leuprorelin group and (2.4 ± 1.3) U/L in diphereline group before Gn administration, which reached statistical difference (P < 0.05). The mean length of Gn stimulation were (9.8 ± 1.7) days in low dose leuprorelin group, (10.5 ± 1.8) days in high dose of leuprorelin group and (11.1 ± 1.4) days in diphereline group, which reached statistical difference (P < 0.05). The mean dose of Gn was (24 ± 7) in low dose of leuprorelin group, which was significantly higher than (27 ± 9) in high dose of leuprorelin group and (28 ± 7) in diphereline group (P < 0.05). The level of LH was (2.7 ± 1.6) U/L in low dose of leuprorelin group and (2.2 ± 1.0) U/L in diphereline group before Gn administration, which reached statistical difference (P < 0.05). The cancel cycles were 5 in low dose of leuprorelin group, 4 in high dose of leuprorelin group and 7 in diphereline group. The number of ovum was (14 ± 7) low dose of leuprorelin group, (13 ± 6) in high dose of leuprorelin group, (14 ± 6) in diphereline group. The rates of fertilization was 66.26% (758/1144) in low dose of leuprorelin group, 67.01% (589/879) in high dose of leuprorelin group and 68.54% (1111/1621) in diphereline group, the rates of good-quality embryos was 64.22% (472/735) in low dose of leuprorelin group, 60.50% (340/562) in high dose of leuprorelin group and 59.59% (640/1074) in diphereline group, clinical pregnancy was 49% (38/78) in low dose of leuprorelin group, 42% (27/64) in high dose of leuprorelin group and 50% (55/110) in diphereline group, early miscarriage was 18% (7/38) in low dose of leuprorelin group, 15% (4/27) in high dose of leuprorelin group and 15% (8/55) in diphereline group, which did not show significant differences (P > 0.05).
Both 1.25 mg and 1.88 mg leuprorelin acetate could obtain good down-regulation effect and clinical outcomes. 1.25 mg leuprorelin acetate could decrease patient's costs by reducing Gn dose and duration.
评估不同剂量醋酸亮丙瑞林在体外受精-胚胎移植（IVF-ET）中的临床效果。
回顾性分析2011年1月至2011年12月在安徽医科大学解放军临床学院生殖医学中心接受IVF和（或）卵胞浆内单精子注射（ICSI）的268例患者的数据。所有患者根据长方案和控制性卵巢刺激（COH）分为三组，低剂量组83个周期使用1.25mg醋酸亮丙瑞林，高剂量组68个周期使用1.88mg醋酸亮丙瑞林，对照组117个周期使用1.25mg达必佳。检测月经周期第3-5天和注射hCG当天促性腺激素（Gn）给药前的血清卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E₂）和孕酮（P），比较三组Gn的剂量和使用时间、获卵数、成熟卵母细胞数、受精率、胚胎分裂率、优质胚胎率、临床妊娠率和早期流产率。
三组患者年龄、注射hCG当天LH和P水平比较，差异无统计学意义（P>0.05）。Gn给药前，低剂量醋酸亮丙瑞林组FSH水平为（3.8±1.6）U/L，高剂量醋酸亮丙瑞林组为（3.1±1.4）U/L，达必佳组为（2.4±1.3）U/L，差异有统计学意义（P<0.05）。低剂量醋酸亮丙瑞林组Gn刺激平均时长为（9.8±1.7）天，高剂量醋酸亮丙瑞林组为（10.5±1.8）天，达必佳组为（11.1±1.4）天，差异有统计学意义（P<0.05）。低剂量醋酸亮丙瑞林组Gn平均剂量为（24±7），显著高于高剂量醋酸亮丙瑞林组的（27±9）和达必佳组的（28±7）（P<0.05）。Gn给药前，低剂量醋酸亮丙瑞林组LH水平为（2.7±1.6）U/L，达必佳组为（2.2±1.0）U/L，差异有统计学意义（P<0.05）。低剂量醋酸亮丙瑞林组取消周期5个，高剂量醋酸亮丙瑞林组4个，达必佳组7个。低剂量醋酸亮丙瑞林组获卵数为（14±7）个，高剂量醋酸亮丙瑞林组为（13±6）个，达必佳组为（14±6）个。低剂量醋酸亮丙瑞林组受精率为66.26%（758/1144），高剂量醋酸亮丙瑞林组为67.01%（589/879），达必佳组为68.54%（1111/1621）；低剂量醋酸亮丙瑞林组优质胚胎率为64.22%（472/735），高剂量醋酸亮丙瑞林组为60.50%（340/562），达必佳组为59.59%（640/1074）；临床妊娠率低剂量醋酸亮丙瑞林组为49%（38/78），高剂量醋酸亮丙瑞林组为42%（27/64），达必佳组为50%（55/110）；早期流产率低剂量醋酸亮丙瑞林组为18%（7/38），高剂量醋酸亮丙瑞林组为15%（4/27），达必佳组为15%（8/55），差异均无统计学意义（P>0.05）。
1.25mg和1.88mg醋酸亮丙瑞林均能获得良好的降调节效果和临床结局。1.25mg醋酸亮丙瑞林可通过减少Gn剂量和使用时间降低患者费用。
