GnRH激动剂长方案与拮抗剂方案在COH中激素变化以及临床疗效比较

发布时间：2018-05-01 12:07

本文选题：体外受精-胚胎移植 + 拮抗剂方案　；参考：《山东大学》2017年硕士论文

【摘要】：第一部分GnRH激动剂长方案与GnRH拮抗剂方案在促排卵过程中激素水平比较研究目的通过对采取促性腺激素释放激素激动剂长方案(GnRH-a)和促性腺激素释放激素拮抗剂方案(GnRH-ant)进行体外受精-胚胎移植(In vitro fertilization and embryo transfer,IVF-ET)的患者在促排卵过程中不同时间点的激素测定,分析两种方案对下丘脑-垂体-卵巢轴的影响,为两种方案在临床的合理应用提供依据。研究方法选取2015年10月--2016年3月,30例于山东大学齐鲁医院生殖中心首次接受IVF-ET治疗的25～35岁不孕女性。15例使用GnRH-a长方案(Ⅰ组)进行超促排卵,15例应用GnRH-ant方案(Ⅱ组)。30例患者检测:(1)Gn使用日FSH、LH、E2、P水平(基础值);(2)Gn第5天、第7天、HCG日、取卵日血清FSH、LH、E2、P水平;(3)移植日、移植后3天、移植后5天血清FSH、LH、E2水平;(4)移植后第14天血清HCG、FSH、LH水平。比较不同方案下,不同时期的血清激素水平,将两种方案不同时间点的激素水平绘制曲线,比较两种方案各自的激素变化规律,探讨两种方案对下丘脑-垂体-卵巢轴作用的不同。研究结果1.组Ⅰ患者由于经过了垂体降调节过程,Gn启动日、Gn使用第5天后血清E2水平低于组Ⅱ,差异具有统计学意义。Gn第7天组Ⅰ患者E2水平低于组Ⅰ。两组差异无统计学意义。HCG日、取卵日及移植日组Ⅱ患者E2水平均低于组Ⅰ,但差异不具有统计学意义。胚胎移植后第3天及第5天,组Ⅰ患者E2水平低于组Ⅱ,移植第5天差异具有统计学意义。两组患者E2水平整体变化趋势一致。2.组Ⅰ患者因垂体降调节,Gn启动日血清FSH低于组Ⅱ。差异具有统计学意义。进入促排卵后及移植后各时间点血清FSH水平两组对比均无统计学意义。两组患者血清FSH水平整体变化趋势一致。3.组Ⅰ患者Gn启动日血清LH水平低于组Ⅱ,差异具有统计学意义。Gn第7天及HCG注射日组Ⅰ患者LH水平高于组Ⅱ。取卵日,移植日,移植后第3天及移植后第5天组Ⅰ患者LH水平均低于组Ⅱ,差异具有统计学意义(P0.05);移植后第14天两组LH水平无明显差异。4.两组患者Gn启动日,Gn使用第5天、第7天,HCG日血清P水平均无显著差异(P0.05)。研究结论1.GnRH激动剂长方案与拮抗剂方案在超促排卵过程中患者血清E2变化趋势一致。2.GnRH激动剂长方案与拮抗剂方案在超促排卵过程中患者血清FSH变化趋势一致。3.GnRH拮抗剂能够快速抑制垂体功能,降低血清LH水平,可有效预防早发的LH峰,防止卵泡早排。4.停用GnRH-a或GnRH-ant后,患者血清LH均持续下降,长方案组患者LH下降幅度大维持于低水平,即长方案组对垂体抑制作用较拮抗剂更深。5.长方案组停用GnRH-a后,LH明显降低,证明使用长方案促排卵的患者尽管经过了垂体降调节,在促排卵过程中GnRH-a对垂体仍有一定的刺激作用,垂体仍存在一定反应性。第二部分GnRH长方案与拮抗剂方案在胚胎学和临床结局的比较研究目的探讨一般情况相似的患者在体外受精-胚胎移植周期中使用GnRH拮抗剂方案以及黄体期GnRH激动剂长方案在实验室指标和临床结局的差异,为合理选择超促排卵方案提供依据。研究方法收集2015年1月至2016年6月于山东大学齐鲁医院不孕不育诊疗中心行长方案助孕的248个周期(Ⅰ组),按照1:1配对选取拮抗剂方案周期248个(Ⅱ组),统计两种方案Gn使用总量、Gn使用天数、HCG日E2水平、获卵数、MⅡ卵子数、可移植胚胎数、生化妊娠率及临床妊娠率差异。研究结果1.两组患者的一般情况比较无显著差异。2.组Ⅰ患者Gn使用总量低于组Ⅱ,差异无统计学意义(P0.05);Gn使用天数高于组Ⅱ,差异具有统计学意义(P=0.004)。组Ⅰ患者HCG日E2水平高于组Ⅱ,差异具有统计学意义(P0.05)。3.组Ⅰ获卵数高于组Ⅱ,差异无统计学意义(P0.05),MⅡ卵子数高于Ⅱ组,差异无统计学意义(P0.05);组Ⅰ可移植胚胎数高于组Ⅱ,差异具有统计学意义(P=0.013)。4.组Ⅰ共移植272个周期,生化妊娠率为67%,高于组Ⅱ(55.3%),其差异具有统计学意义(P=0.04);组Ⅰ临床妊娠率为55.9%,相比组Ⅱ(49.5%)差异不具有统计学意义(P=0.076)。其中新鲜移植周期两组生化妊娠率、临床妊娠率及流产率均无显著差异。研究结论1.卵巢功能正常的患者在IVF周期中应用拮抗剂方案与长方案在新鲜移植周期妊娠结局方面无显著性差异。2.对于一般情况相似的患者,应用拮抗剂方案可获得与长方案相近的成熟卵子数及可移植胚胎数。3.拮抗剂方案治疗周期短,应用方便灵活。4.拮抗剂方案可以减少卵巢过度刺激综合征的发生,提高试管治疗的安全性。
[Abstract]:The first part of the GnRH agonist regimen and the GnRH antagonist regimen for the comparison of the hormone levels during the ovulation promotion objective by using the gonadotropin releasing hormone agonist (GnRH-a) and the gonadotropin releasing hormone antagonist scheme (GnRH-ant) for in vitro sperm embryo transfer (In vitro fertilization and embryo TRA) The patients in nsfer, IVF-ET) were measured at different time points during the process of ovulation, analyzed the effect of two schemes on the hypothalamus pituitary ovary axis, and provided the basis for the rational application of the two schemes. The study method was selected in March October 2015 --2016, 30 cases in the reproductive center of Qilu Hospital of Shandong University, 2 for the first time. 5~35 year old female infertile women.15 using GnRH-a long program (group I) for superovulation, 15 cases of GnRH-ant scheme (Group II).30 patients test: (1) Gn use day FSH, LH, E2, P level (basic value); (2) Gn fifth days, seventh days, HCG day, egg day serum FSH, 3 days after transplantation, 3 days after transplantation, transplantation, 5 days after transplantation; (4) shift The serum levels of HCG, FSH and LH after fourteenth days were compared. Compared the levels of serum hormones at different periods, the levels of hormone levels of the two schemes at different time points were plotted, and the changes of the hormones in the two schemes were compared and the effects of the two schemes on the hypothalamus hypophysis ovary axis were discussed. The results of the study of the 1. groups of I patients had passed through the study. The pituitary descending regulation process, Gn start day, Gn fifth days after the use of serum E2 level is lower than group II, the difference is statistically significant.Gn seventh days, E2 level is lower than group I. Two groups of no statistical significance.HCG days, the egg day and transplantation group II patients E2 level is lower than group I, but the difference is not statistically significant. Embryo transplantation after the first time. 3 and 5 days, the level of E2 in group I was lower than that of group II, and the difference between the two groups was statistically significant. The overall change trend of E2 level in group.2. was consistent with the regulation of pituitary descending in.2. group I, and the serum FSH of Gn was lower than group II. The difference was statistically significant. The two groups of serum FSH levels after ovulation induction and after transplantation were compared. There was no statistical significance. The overall change trend of serum FSH level in the two groups was consistent with that of group I in.3. group I on the start day of Gn, the level of serum LH was lower than that of group II. The difference was statistically significant in.Gn seventh days and HCG injection day group I was higher than group II. The egg day, transplant day, third days after transplantation and fifth days after transplantation were lower than those of the group. The difference was statistically significant (P0.05), and there was no significant difference in the level of LH in group.4. two after fourteenth days of transplantation. There was no significant difference in serum P level between Gn fifth days, seventh days and HCG day (P0.05). Conclusion 1.GnRH agonist long scheme and antagonist plan in the process of superovulation were consistent.2.GnRH. The change trend of serum FSH in patients with agonist and antagonist in superovulation is consistent with.3.GnRH antagonist can quickly inhibit pituitary function and reduce serum LH level, can effectively prevent early onset of LH peak, prevent the early follicle.4. to stop using GnRH-a or GnRH-ant, the patient's serum LH continues to decrease, the decrease of the patients in the long Fang case group is reduced. The degree of degree maintained at the low level, that is, the long scheme group had a deeper hypophysis inhibition than the antagonist of the antagonist, and the LH was significantly reduced after the discontinuation of GnRH-a in the.5. group. It proved that the GnRH-a had a certain stimulating effect on the pituitary in the process of ovulation promoting and the pituitary still had a certain reactivity in the hypophysis process. Second Comparative study on the embryology and clinical outcome of the GnRH long plan and antagonist regimen in order to explore the difference between the use of the GnRH antagonist in the cycle of in vitro fertilization and embryo transfer and the difference in the laboratory and clinical outcome of the case of the luteal phase GnRH agonist in the period of in vitro fertilization and embryo transfer, and to provide the basis for the rational selection of the superovulation scheme. According to the method, the method collected 248 cycles (group I) from January 2015 to June 2016 at the infertility diagnosis and treatment center of Qilu Hospital of Shandong University (group I). 248 groups (Group II) were selected according to 1:1. The total amount of two schemes of Gn, the number of Gn use days, the E2 level of HCG day, the number of eggs, the number of M II eggs, and the transplantable embryos Number, biochemical pregnancy rate and clinical pregnancy rate difference. Results 1. the general situation of the 1. two groups had no significant difference. The total amount of Gn used in group I patients was lower than group II, the difference was not statistically significant (P0.05); the use days of Gn was higher than group II, the difference was statistically significant (P= 0.004). The E2 level of group I was higher than that of group II in group I, and the difference was unified. The number of acquired eggs in group.3. (P0.05) was higher than group II, the difference was not statistically significant (P0.05), the number of M II eggs was higher than that in group II (P0.05). The number of transplanted embryos in group I was higher than group II, and the difference was statistically significant (P=0.013).4. group I was transplanted for 272 cycles, the rate of biochemical pregnancy was 67%, higher than group II (55.3%), and the difference was different. There was a statistical significance (P=0.04); group I clinical pregnancy rate was 55.9%, compared with group II (49.5%), the difference was not statistically significant (P=0.076). There was no significant difference between two groups of biochemical pregnancy rate, clinical pregnancy rate and abortion rate in the fresh transplant period. Conclusion 1. patients with normal ovarian function were used in the IVF cycle with antagonist scheme and long prescription case. There is no significant difference in the outcome of pregnancy in fresh grafts..2. for patients with similar conditions, the number of mature ova and the number of transplantable embryo.3. antagonists are short, and the application of a convenient and flexible.4. antagonist scheme can reduce the occurrence of ovarian hyperstimulation syndrome. To improve the safety of tube treatment.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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