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目的 (1)在促性腺激素释放激素拮抗剂(GnRH-ant)方案中应用促性腺激素释放激素激动剂(GnRH-a)诱发卵母细胞最终成熟后,在黄体支持方案中比较孕激素+人绒毛膜促性腺激素(HCG)和孕激素+雌激素两种不同的黄体支持方案对妊娠结局的影响;(2)在GnRH-ant方案中比较添加高纯度人绝经期促性腺激素(HP-HMG)和添加人重组黄体生成素(rLH)对妊娠结局的影响。方法前瞻随机对照的临床实验。对照组32例,添加rLH,GnRH-a诱发卵母细胞最终成熟后12 h添加1,000 IU、35 h添加500 IU HCG,取卵后应用孕激素;实验Ⅰ组37例,添加HP-HMG,黄体支持方案同对照组;实验Ⅱ组33例,添加HP-HMG,取卵后应用孕激素和雌激素。结果对照组、实验Ⅰ组和实验Ⅱ组的新鲜周期胚胎移植周期临床妊娠率分别是38.10%、23.08%和8.70%,实验Ⅱ组新鲜周期临床妊娠率明显低于本中心质控标准,该临床实验提前终止。对照组、实验Ⅰ组和实验Ⅱ组未妊娠者已有33例进行了冷冻胚胎移植周期,其临床妊娠率分别为50.00%,63.64%和57.14%。三组均无中重度卵巢过度刺激综合征(OHSS)发生。结论拮抗剂方案中应用GnRH-a诱发卵母细胞成熟可以避免中重度OHSS的发生,且不影响胚胎质量。GnRH激动剂诱发卵母细胞成熟对黄体功能和内膜容受性存在不利影响,单纯补充雌孕激素无法替代HCG的作用。
PURPOSE: (1) To compare the effect of progesterone + human progesterone after progesterone-releasing hormone agonist (GnRH-a) -induced oocyte maturation in the gonadotropin-releasing hormone antagonist Chorionic gonadotropin (HCG) and progesterone + estrogen on pregnancy outcome; (2) compared with high-purity human menopausal gonadotropin (HP-HMG ) And human recombinant luteinizing hormone (rLH) on pregnancy outcome. Methods Prospective randomized controlled clinical trials. In the control group, 32 cases were treated with rLH and GnRH-a to induce 1,000 IU after 12 h of final maturation, 500 IU of HCG after 35 h and progesterone after ovulation. 37 cases of experimental group Ⅰ were given HP-HMG and corpus luteum Support program with the control group; experimental group II 33 cases, add HP-HMG, ovulation after the application of progesterone and estrogen. Results The clinical pregnancy rates of fresh cycle embryo transfer in control group Ⅰ and group Ⅱ were 38.10%, 23.08% and 8.70% respectively. The clinical pregnancy rate of fresh group in experimental group Ⅱ was significantly lower than the quality control standard of this center The experiment was terminated early. In the control group, 33 cases of non-pregnant women in experimental group I and II group had frozen embryo transfer cycle, the clinical pregnancy rates were 50.00%, 63.64% and 57.14% respectively. None of the three groups had moderate to severe ovarian hyperstimulation syndrome (OHSS). Conclusion GnRH-a-induced oocyte maturation in the antagonist regimen can avoid the occurrence of moderate-severe OHSS and does not affect the embryo quality. GnRH agonist-induced oocyte maturation on luteal function and endometrial receptivity adversely affected, simply replace estrogen and progesterone can not replace the role of HCG.