促性腺激素释放激素拮抗剂治疗卵泡提前黄素化

摘要

目的 小剂量促性腺激素释放激素(GnRH)拮抗剂用于促排卵方案,研究其对卵泡提前黄素化的治疗效果.方法 选取15例反复发生卵泡提前黄素化的患者,分别进行两个周期促排卵治疗行夫精人工授精,A组进行常规促排卵治疗,B组加用西曲瑞克0.125mg/d促排卵治疗.观察治疗结局.结果 A组15个周期,发生卵泡提前黄素化13例,B组15个周期,发生卵泡提前黄素化1例,有显著差异(P<0.01)；A组HCG日LH(12.2±8.6)IU/L,孕酮(2.7±1.9)ng/mL,B组：HCG日LH(4.0±4.8)IU/L(P=0.008),孕酮(0.9±1.8) ng/mL(P=0.012),均有显著差异；A组使用HMG用量(750.0±138.8)IU,HCG日E2(607.4±315.3)pg/mL,优势卵泡(2.0±1.1)个,卵泡最大直径(17.5±0.8)mm,子宫内膜厚度(10.1±1.5)mm；B组使用HMG用量(907.5±208.4)IU(P=0.003),HCG日E2(1264.0±763.4)pg/mL(P=0.006),优势卵泡(3.2±1.5)个(P=0.044),卵泡最大直径(18.1±0.7)mm(P=0.013),均有显著差异,子宫内膜厚度(11.1±1.6)mm(P=0.062),没有统计学差异.结论 促排卵治疗过程中加入西曲瑞克0.125mg/d可以有效减少卵泡提前黄素化发生率,促排卵后成熟卵泡增多,子宫内膜没有出现显著变化.%　　Objective Low doses of ganodotropin releasing hormone (GnRH) antagonist were added to the follicle stimulation protocol to explore its effect on the follicle premature luteinization. Method  15 patients with recurrent follicle premature luteinization were recruited to the follicle stimulation protocols and intrauterine insemination treatment. Every patient received two cycles of treatment. In group A, the patients received HMG stimulation; In group B, the patients received HMG+cetrorelix0.125mg stimulation, and the patients in both groups received intrauterine insemination. Result  In group A, 13 of 15 cycles resulted in premature luteinization whereas 1 of 15 resulted in premature luteinization in group B, difference was significant(P<0.01). Luteinization hormone (LH) on the day of HCG injection was (12.2±8.6)IU/L in group A and (4.0±4.8)IU/L in group B (P=0.008), Progesterone (P) was (2.7±1.9)ng/mL in group A and (0.9±1.8)ng/mL in group B (P=0.012); The HMG amounts was 750.0±138.8IU in group A and 907.5±208.4IU in group B(P=0.003); the dominant follicle number was (2.0±1.1) in group A and (3.2±1.5) in group B (P=0.044); the average diameter was (17.5±0.8)mm in group A and (18.1 ±0.7)mm  in group B (P=0.013). Significant difference was found in LH, P, HMG amounts, dominant follicle number and average diameter between the two groups. The endometrium thickness was (10.1±1.5)mm in group A and (11.1±1.6)mm in group B (P=0.062), difference was not significant. Conclusion Cetrorelix 0.125mg per day is added to the follicle stimulation protocol to inhibit follicle premature luteinization which increases mature follicles and has no effect on endometrium thickness.