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目的探讨促性腺激素释放激素激动剂(GnRH-a)超长方案降调节对中重度子宫内膜异位症患者体外受精-胚胎移植(IVF-ET)胚胎种植率和临床妊娠率的影响。方法回顾性分析2012年6月—2016年7月在第二军医大学长海医院生殖医学中心采用IVF-ET助孕的120例子宫内膜异位症患者的临床资料,患者行IVF-ET助孕时分别选择GnRH-a超长方案(n=42)、长方案(n=38)或短方案(n=40)。分析比较:(1)3组患者的年龄,不孕年限,基础卵泡刺激素、促黄体生成素(LH)和雌二醇(E2)的水平,以及人绒毛膜促性腺激素(hCG)日LH、E2和孕酮的水平;(2)3组患者的平均取卵数、MⅡ卵子数、受精率、卵裂率、可用胚胎数、胚胎种植率和临床妊娠率。结果 (1)3组患者一般资料差异无统计学意义。(2)超长方案和长方案组患者hCG日的LH和孕酮水平均低于短方案组(P均<0.05)。(3)超长方案组患者的受精率、卵裂率、胚胎种植率和临床妊娠率均高于短方案组(P<0.05)。结论中重度子宫内膜异位症患者在腹腔镜或开腹手术切除病灶后,行IVF-ET助孕时应用超长方案可提高临床妊娠率与胚胎种植率。
Objective To investigate the effects of gonadotropin-releasing hormone agonist (GnRH-a) regimen on the embryo implantation rate and clinical pregnancy rate of in vitro fertilization-embryo transfer (IVF-ET) in patients with moderate-severe endometriosis. Methods The clinical data of 120 patients with endometriosis who underwent IVF-ET in the Reproductive Medicine Center of Changhai Hospital, Second Military Medical University from June 2012 to July 2016 were retrospectively analyzed. The patients underwent IVF-ET assisted pregnancy GnRH-a long arm (n = 42), long arm (n = 38) or short arm (n = 40) were selected. Analysis and comparison: (1) The age, duration of infertility, basal follicle stimulating hormone, luteinizing hormone (LH) and estradiol (E2) and the level of human chorionic gonadotropin (hCG) , E2 and progesterone; (2) The average numbers of oocytes, M Ⅱ oocytes, fertilization rate, cleavage rate, number of available embryos, embryo implantation rate and clinical pregnancy rate in 3 groups of patients. Results (1) There was no significant difference in general data between the three groups. (2) The levels of LH and progesterone on the day of hCG in the long-term and long-term patients were lower than those in the short-term group (all P <0.05). (3) The fertilization rate, cleavage rate, embryo implantation rate and clinical pregnancy rate of patients in the extra-long-term group were higher than those in the short-term group (P <0.05). Conclusion In patients with moderate-severe endometriosis, laparoscopic or laparotomy resection of the lesion, IVF-ET assisted pregnancy regimen can be used to increase long-term clinical pregnancy rate and embryo implantation rate.