本文選題：體外受精-胚胎移植 + 拮抗劑方案��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：第一部分GnRH激動(dòng)劑長方案與GnRH拮抗劑方案在促排卵過程中激素水平比較研究目的通過對采取促性腺激素釋放激素激動(dòng)劑長方案(GnRH-a)和促性腺激素釋放激素拮抗劑方案(GnRH-ant)進(jìn)行體外受精-胚胎移植(In vitro fertilization and embryo transfer,IVF-ET)的患者在促排卵過程中不同時(shí)間點(diǎn)的激素測定,分析兩種方案對下丘腦-垂體-卵巢軸的影響,為兩種方案在臨床的合理應(yīng)用提供依據(jù)。研究方法選取2015年10月--2016年3月,30例于山東大學(xué)齊魯醫(yī)院生殖中心首次接受IVF-ET治療的25～35歲不孕女性。15例使用GnRH-a長方案(Ⅰ組)進(jìn)行超促排卵,15例應(yīng)用GnRH-ant方案(Ⅱ組)。30例患者檢測:(1)Gn使用日FSH、LH、E2、P水平(基礎(chǔ)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。比較不同方案下,不同時(shí)期的血清激素水平,將兩種方案不同時(shí)間點(diǎn)的激素水平繪制曲線,比較兩種方案各自的激素變化規(guī)律,探討兩種方案對下丘腦-垂體-卵巢軸作用的不同。研究結(jié)果1.組Ⅰ患者由于經(jīng)過了垂體降調(diào)節(jié)過程,Gn啟動(dòng)日、Gn使用第5天后血清E2水平低于組Ⅱ,差異具有統(tǒng)計(jì)學(xué)意義。Gn第7天組Ⅰ患者E2水平低于組Ⅰ。兩組差異無統(tǒng)計(jì)學(xué)意義。HCG日、取卵日及移植日組Ⅱ患者E2水平均低于組Ⅰ,但差異不具有統(tǒng)計(jì)學(xué)意義。胚胎移植后第3天及第5天,組Ⅰ患者E2水平低于組Ⅱ,移植第5天差異具有統(tǒng)計(jì)學(xué)意義。兩組患者E2水平整體變化趨勢一致。2.組Ⅰ患者因垂體降調(diào)節(jié),Gn啟動(dòng)日血清FSH低于組Ⅱ。差異具有統(tǒng)計(jì)學(xué)意義。進(jìn)入促排卵后及移植后各時(shí)間點(diǎn)血清FSH水平兩組對比均無統(tǒng)計(jì)學(xué)意義。兩組患者血清FSH水平整體變化趨勢一致。3.組Ⅰ患者Gn啟動(dòng)日血清LH水平低于組Ⅱ,差異具有統(tǒng)計(jì)學(xué)意義。Gn第7天及HCG注射日組Ⅰ患者LH水平高于組Ⅱ。取卵日,移植日,移植后第3天及移植后第5天組Ⅰ患者LH水平均低于組Ⅱ,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);移植后第14天兩組LH水平無明顯差異。4.兩組患者Gn啟動(dòng)日,Gn使用第5天、第7天,HCG日血清P水平均無顯著差異(P0.05)。研究結(jié)論1.GnRH激動(dòng)劑長方案與拮抗劑方案在超促排卵過程中患者血清E2變化趨勢一致。2.GnRH激動(dòng)劑長方案與拮抗劑方案在超促排卵過程中患者血清FSH變化趨勢一致。3.GnRH拮抗劑能夠快速抑制垂體功能,降低血清LH水平,可有效預(yù)防早發(fā)的LH峰,防止卵泡早排。4.停用GnRH-a或GnRH-ant后,患者血清LH均持續(xù)下降,長方案組患者LH下降幅度大維持于低水平,即長方案組對垂體抑制作用較拮抗劑更深。5.長方案組停用GnRH-a后,LH明顯降低,證明使用長方案促排卵的患者盡管經(jīng)過了垂體降調(diào)節(jié),在促排卵過程中GnRH-a對垂體仍有一定的刺激作用,垂體仍存在一定反應(yīng)性。第二部分GnRH長方案與拮抗劑方案在胚胎學(xué)和臨床結(jié)局的比較研究目的探討一般情況相似的患者在體外受精-胚胎移植周期中使用GnRH拮抗劑方案以及黃體期GnRH激動(dòng)劑長方案在實(shí)驗(yàn)室指標(biāo)和臨床結(jié)局的差異,為合理選擇超促排卵方案提供依據(jù)。研究方法收集2015年1月至2016年6月于山東大學(xué)齊魯醫(yī)院不孕不育診療中心行長方案助孕的248個(gè)周期(Ⅰ組),按照1:1配對選取拮抗劑方案周期248個(gè)(Ⅱ組),統(tǒng)計(jì)兩種方案Gn使用總量、Gn使用天數(shù)、HCG日E2水平、獲卵數(shù)、MⅡ卵子數(shù)、可移植胚胎數(shù)、生化妊娠率及臨床妊娠率差異。研究結(jié)果1.兩組患者的一般情況比較無顯著差異。2.組Ⅰ患者Gn使用總量低于組Ⅱ,差異無統(tǒng)計(jì)學(xué)意義(P0.05);Gn使用天數(shù)高于組Ⅱ,差異具有統(tǒng)計(jì)學(xué)意義(P=0.004)。組Ⅰ患者HCG日E2水平高于組Ⅱ,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.組Ⅰ獲卵數(shù)高于組Ⅱ,差異無統(tǒng)計(jì)學(xué)意義(P0.05),MⅡ卵子數(shù)高于Ⅱ組,差異無統(tǒng)計(jì)學(xué)意義(P0.05);組Ⅰ可移植胚胎數(shù)高于組Ⅱ,差異具有統(tǒng)計(jì)學(xué)意義(P=0.013)。4.組Ⅰ共移植272個(gè)周期,生化妊娠率為67%,高于組Ⅱ(55.3%),其差異具有統(tǒng)計(jì)學(xué)意義(P=0.04);組Ⅰ臨床妊娠率為55.9%,相比組Ⅱ(49.5%)差異不具有統(tǒng)計(jì)學(xué)意義(P=0.076)。其中新鮮移植周期兩組生化妊娠率、臨床妊娠率及流產(chǎn)率均無顯著差異。研究結(jié)論1.卵巢功能正常的患者在IVF周期中應(yīng)用拮抗劑方案與長方案在新鮮移植周期妊娠結(jié)局方面無顯著性差異。2.對于一般情況相似的患者,應(yīng)用拮抗劑方案可獲得與長方案相近的成熟卵子數(shù)及可移植胚胎數(shù)。3.拮抗劑方案治療周期短,應(yīng)用方便靈活。4.拮抗劑方案可以減少卵巢過度刺激綜合征的發(fā)生,提高試管治療的安全性。
[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.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.8

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