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目的:比较体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)控制性超促排卵(COH)中3种不同促排卵药物的临床疗效。方法:回顾性分析行IVF/ICSI治疗的3种COH方案[短方案、长方案与克罗米芬(CC)+促性腺激素(Gn)方案]不孕症患者的3 347个移植周期的临床资料。3种COH方案内再各分为3个组,分别为高纯度尿促性素(HP-h MG)组、人尿促性素(h MG)组、重组卵泡刺激素(r FSH)组。比较3组患者给予Gn的时间、Gn用量、人绒毛膜促性腺激素(h CG)注射日雌二醇(E2)、孕酮(P)水平及子宫内膜厚度、获卵数、受精率、卵裂率、有效胚胎率、平均移植胚胎数、临床妊娠率和种植率。结果:h MG组无论在Gn使用的天数和剂量上,都显著高于HP-h MG组与r FSH组。在CC+Gn方案中,HP-h MG组在h CG注射日E2峰值最低。在长方案中,HP-h MG组h CG注射日的P水平最低(P<0.05)。3种方案中各组的h CG注射日子宫内膜厚度、获卵数、受精率、卵裂率、有效胚胎率、平均移植胚胎数、临床妊娠率与种植率比较,均无统计学差异(P>0.05)。结论:HP-h MG在h CG注射日具有较低P水平,使得内膜更利于胚胎着床,其COH临床效果上与其他促排卵药物一样有效、安全。
OBJECTIVE: To compare the clinical efficacy of three different ovulation-promoting drugs in IVF / ICSI-ET controlled ovarian hyperstimulation (COH) in vitro fertilization / intracytoplasmic sperm injection-embryo transfer. Methods: The clinical data of 3 347 transplant cycles of 3 COH regimens [short regimen, long regimen and clomiphene citrate (CC) + gonadotropin (Gn) regimen] infertility treated with IVF / ICSI were retrospectively analyzed. The three COH regimens were divided into three groups: high-purity urinary hgprone (hMG) group, human urinary hMG (h MG) group, and recombinant follicle stimulating hormone (rFSH) group. Gn administration, Gn dosage, estradiol (E2), progesterone (P) levels, endometrial thickness, number of retrieved oocytes, fertilization rate, Cleavage rate, effective embryo rate, average number of transferred embryos, clinical pregnancy rate and implantation rate. Results: The h MG group was significantly higher than the HP-h MG group and the r FSH group in terms of days and doses of Gn. In the CC + Gn regimen, the peak E2 of E2 in HP-h MG group was the lowest on h CG injection day. In the long-term regimen, h-P MG levels in HP-h MG group were the lowest (P <0.05). Endometrial thickness, number of retrieved oocytes, fertilization rate, cleavage rate, effective embryo rate, average number of embryos transferred, clinical pregnancy rate and implantation rate were not significantly different among the three groups P> 0.05). CONCLUSIONS: HP-h MG has a low P level on h CG injection day, which makes endomembrane more conducive to embryo implantation. Its COH clinical efficacy is as effective and safe as other ovulation induction drugs.