Huang Yun, Shuai Mei, Yue Linlin, Liao Hua
Department of Reproduction and Genetics, Ganzhou Maternal and Child Health Centre Ganzhou, Jiangxi Province, China.
Am J Transl Res. 2021 Jul 15;13(7):8365-8371. eCollection 2021.
To investigate the clinical application of gonadotropin-releasing hormone antagonist (GnRH-ant) in patients with failed pregnancy assisted by the previous long-term regimen during early follicular phase (EFP).
A total of 122 patients with good ovarian function and two previous failed EFP long-term assisted pregnancy were selected from the reproductive center of our hospital for study. All patients were assisted by in vitro fertilization-embryo transfer (IVF-ET) twice. According to the random number table method, the participants were divided into group A (n=61) for subcutaneous injection of gonadotropin-releasing hormone agonist (GnRH-a) and group B (n=61) for GnRH-ant, and the clinical efficacy of the two groups were observed.
Group B presented reduced dosage and duration of Gn, increased number and probability of eggs retrieved, and increased number of 2PN, cleavage and transplantable embryos than group A (all P<0.05). Serum estradiol (E2) and luteinizing hormone (LH) levels elevated and T level decreased in group B as compared to group A (all P<0.05). There was no significant difference in follicle-stimulating hormone (FSH) indexes between the two groups (P>0.05). Endometrial thickness and mean ovarian volume (MOV, the mean volume of bilateral ovaries) were not significantly different between group A and group B before treatment (both P>0.05), while were lower in group B than in group A after treatment (both P<0.05). Group B had higher high-quality egg rate (%), fertilization rate (should have numbers here %), cleavage rate (%), high-quality embryo rate (should have numbers here %) and cumulative pregnancy rate (%) than group A (all P<0.05). The incidences of moderate OHSS, early abortion and hydrosalpinx were lower in group B than in group A (all P<0.05), while there was no evident difference between the two groups in the occurrence of severe OHSS and ectopic pregnancy (both P>0.05).
GnRH-ant can improve the clinical high-quality embryo rate in patients with the previous failed EFP long-term assisted pregnancy, and reduce the occurrence of OHSS events. Compared with GnRH-a, GnRH-ant is more suitable for clinical application of controlled ovarian hyperstimulation.
探讨促性腺激素释放激素拮抗剂（GnRH-ant）在既往卵泡早期长期方案助孕失败患者中的临床应用。
从我院生殖中心选取122例卵巢功能良好且既往两次卵泡早期长期助孕失败的患者进行研究。所有患者均接受两次体外受精-胚胎移植（IVF-ET）助孕。根据随机数字表法，将参与者分为A组（n = 61）皮下注射促性腺激素释放激素激动剂（GnRH-a）和B组（n = 61）注射GnRH-ant，观察两组的临床疗效。
与A组相比，B组Gn用量及用药时间减少，获卵数及获卵概率增加，2PN、卵裂及可移植胚胎数增加（均P < 0.05）。与A组相比，B组血清雌二醇（E2）和黄体生成素（LH）水平升高，睾酮（T）水平降低（均P < 0.05）。两组促卵泡生成素（FSH）指标差异无统计学意义（P > 0.05）。治疗前A组和B组子宫内膜厚度及平均卵巢体积（MOV，双侧卵巢平均体积）差异无统计学意义（均P > 0.05），而治疗后B组低于A组（均P < 0.05）。B组优质卵率（%）、受精率（此处应有具体数值）、卵裂率（%）、优质胚胎率（此处应有具体数值）及累积妊娠率（%）均高于A组（均P < 0.05）。B组中度卵巢过度刺激综合征（OHSS）、早期流产及输卵管积水发生率低于A组（均P < 0.05），而两组重度OHSS及异位妊娠发生率差异无明显统计学意义（均P > 0.05）。
GnRH-ant可提高既往卵泡早期长期助孕失败患者的临床优质胚胎率，并降低OHSS事件的发生。与GnRH-a相比，GnRH-ant更适合用于控制性卵巢刺激的临床应用。
