The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang 322000, People's Republic of China.
Department of Assisted Reproduction, Women's Hospital School of Medicine Zhejiang University, Hangzhou, Zhejiang 310006, People's Republic of China.
Drug Des Devel Ther. 2020 Sep 11;14:3673-3682. doi: 10.2147/DDDT.S270519. eCollection 2020.
Gonadotrophin releasing hormone agonist (GnRH-a) is widely used for pituitary down-regulation and recruiting more follicles in assisted reproduction. However, no information is available on its value for patients with thin endometrial thickness.
This was a retrospective cohort study of 302 patients with endometrium <8 mm undergoing fresh embryo transfer at a fertility center of a university hospital from January 2016 and December 2018. In 148 cycles of the GnRH-a prolonged protocol, one depot of 3.75 mg GnRH-a was injected on day 2 of the menstrual cycle, while in 154 cycles of the short GnRH-a long protocol, 0.1 mg of GnRH-a was injected daily from the mid-luteal phase. The live birth rate and clinical pregnancy rate were compared between the two groups. Other outcome measures included the implantation rate, miscarriage rate, and characteristics of stimulation procedures.
Live birth rates and clinical pregnancy rates were significantly higher in the GnRH-a prolonged protocol group than in the other group (36.5% vs 20.8%, =0.002; 43.9% vs 28.2%, =0.006, respectively). The live birth rate was significantly increased in the prolonged protocol group (crude OR: 2.190, 95% CI: 1.311, 3.660; adjusted OR: 2.458, 95% CI: 1.430, 4.224) compared with that in the reference group. The implantation rate of the former group was also significantly higher than that of the latter group (35.4% vs 15.9%, =0.000). There was no significant difference in miscarriage rates between the two protocols. In terms of stimulation procedures, the GnRH-a prolonged protocol group required significantly higher Gn time (10.9 vs 9.5 days, =0.000) and Gn consumption (2625.0 vs 2047.5 IU, =0.000) than the short GnRH-a long protocol group.
The GnRH-a prolonged protocol in fresh embryo transfer cycles yielded better clinical outcomes of patients with thin endometrium than the short GnRH-a long protocol.
促性腺激素释放激素激动剂（GnRH-a）广泛用于垂体下调和辅助生殖中募集更多卵泡。然而，对于薄型子宫内膜患者，其价值尚无信息。
这是一项回顾性队列研究，纳入了 2016 年 1 月至 2018 年 12 月在大学医院生殖中心接受新鲜胚胎移植且子宫内膜<8mm 的 302 例患者。在 GnRH-a 延长方案的 148 个周期中，在月经周期的第 2 天注射 3.75mg GnRH-a 一次；在 GnRH-a 短期长方案的 154 个周期中，从黄体中期开始每天注射 0.1mg GnRH-a。比较两组的活产率和临床妊娠率。其他结局指标包括着床率、流产率和刺激方案的特点。
GnRH-a 延长方案组的活产率和临床妊娠率明显高于其他组（36.5% vs 20.8%，=0.002；43.9% vs 28.2%，=0.006）。延长方案组的活产率明显高于对照组（粗 OR：2.190，95%CI：1.311，3.660；调整 OR：2.458，95%CI：1.430，4.224）。前者的着床率也明显高于后者（35.4% vs 15.9%，=0.000）。两组的流产率无显著差异。在刺激方案方面，GnRH-a 延长方案组的 Gn 时间（10.9 天 vs 9.5 天，=0.000）和 Gn 用量（2625.0IU vs 2047.5IU，=0.000）明显高于短期 GnRH-a 长方案组。
在新鲜胚胎移植周期中，与短期 GnRH-a 长方案相比，GnRH-a 延长方案对薄型子宫内膜患者的临床结局更好。
