Tan S L, Maconochie N, Doyle P, Campbell S, Balen A, Bekir J, Brinsden P, Edwards R G, Jacobs H S
Hallam Medical Centre, London Women's Clinic, King's College School of Medicine and Dentistry, London School of Hygiene and Tropical Medicine, United Kingdom.
Am J Obstet Gynecol. 1994 Aug;171(2):513-20. doi: 10.1016/0002-9378(94)90291-7.
Our purpose was to compare cumulative conception and live-birth rates after in vitro fertilization with and without the use of the long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin.
Life-table analysis of conception and live-birth rates in relation to ovarian stimulation regimen used in 2893 women who had one of five stimulation regimens exclusively throughout all treatment cycles, namely, human menopausal gonadotropin with or without clomiphene citrate; follicle-stimulating hormone with or without clomiphene citrate; and long, short, and ultrashort protocols of buserelin, plus follicle-stimulating hormone or human menopausal gonadotropin; and in an additional 347 women who had been administered both human menopausal gonadotropin and follicle-stimulating hormone with or without clomiphene citrate.
The cumulative conception rate and cumulative live-birth rate were significantly higher in those women treated exclusively with the long buserelin regimen (59% and 55%, respectively, after three cycles) compared with those who only had human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate (39% and 29%, respectively, after three cycles) (p = 0.001 and p = 0.0001) or compared with those who had only short or ultrashort buserelin regimens (22% and 17% after two cycles) (p = 0.0001 and p = 0.005). The pregnancy failure rate in patients on the long buserelin regimen was 22.4% (95% confidence interval 14.8% to 30.0%) compared with 33.3% (95% confidence interval 29.6% to 37.0%) in those who had human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate (p = 0.03). When the probabilities of first conception and first live birth were examined by treatment regimen, after we allowed for the effects of age, cause of infertility, calendar year of treatment, and treatment cycle number (with a multiple logistic regression model), it was found that, relative to human menopausal gonadotropin or follicle-stimulating hormone with or without clomiphene citrate, the odds of conceiving with the long buserelin regimen was 1.63 (95% confidence interval 1.31 to 2.03) (p < 0.001) and the odds of a live birth was 1.97 (95% confidence interval 1.53 to 2.54) (p < 0.001). Similarly, relative to short or ultrashort buserelin the odds of conceiving with long bureselin was 1.88 (95% confidence interval 1.39 to 2.55) (p < 0.001) and the odds of a live birth was 1.79 (95% confidence interval 1.25 to 2.56) (p = 0.001).
Pituitary desensitization with the long protocol of buserelin significantly increases the probabilities of conception and live birth after in vitro fertilization.
我们的目的是比较在体外受精过程中，使用促性腺激素释放激素激动剂布舍瑞林的长方案、短方案和超短方案与不使用这些方案时的累积受孕率和活产率。
对2893名女性的受孕率和活产率进行生命表分析，这些女性在所有治疗周期中仅采用五种刺激方案中的一种，即单独使用人绝经期促性腺激素（有无枸橼酸氯米芬）；单独使用促卵泡生成素（有无枸橼酸氯米芬）；布舍瑞林的长方案、短方案和超短方案加促卵泡生成素或人绝经期促性腺激素；另外还有347名女性，她们使用了人绝经期促性腺激素和促卵泡生成素（有无枸橼酸氯米芬）。
与仅使用人绝经期促性腺激素或促卵泡生成素（有无枸橼酸氯米芬）的女性相比（三个周期后分别为39%和29%）（p = 0.001和p = 0.0001），或与仅使用布舍瑞林短方案或超短方案的女性相比（两个周期后分别为22%和17%）（p = 0.0001和p = 0.005），仅采用布舍瑞林长方案治疗的女性累积受孕率和累积活产率显著更高（三个周期后分别为59%和55%）。布舍瑞林长方案患者的妊娠失败率为22.4%（95%置信区间14.8%至30.0%），而使用人绝经期促性腺激素或促卵泡生成素（有无枸橼酸氯米芬）的患者为33.3%（95%置信区间29.6%至37.0%）（p = 0.03）。当通过治疗方案检查首次受孕和首次活产的概率时，在考虑了年龄、不孕原因、治疗年份和治疗周期数的影响后（采用多元逻辑回归模型），发现相对于人绝经期促性腺激素或促卵泡生成素（有无枸橼酸氯米芬），采用布舍瑞林长方案受孕的几率为1.63（95%置信区间1.31至2.03）（p < 0.001），活产几率为1.97（95%置信区间1.53至2.54）（p < 0.001）。同样，相对于布舍瑞林短方案或超短方案，采用布舍瑞林长方案受孕的几率为1.88（95%置信区间1.39至2.55）（p < 0.001），活产几率为1.79（95%置信区间1.25至2.56）（p = 0.001）。
布舍瑞林长方案进行垂体脱敏显著提高了体外受精后的受孕概率和活产概率。
