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目的比较子宫内膜异位症(EMs)不孕症患者行体外受精-胚胎移植(IVF-ET)助孕前用促性腺激素释放激素激动剂(GnRHa)与避孕药(Oc)预治疗组的临床效果。方法 EMs患者56个周期,分为GnRHa预治疗组的35个周期与Oc预治疗组的21个周期;选取同期单纯输卵管性不孕患者49个周期为对照组。比较Ems患者不同药物预治疗后获卵数、受精率、卵裂率、优质胚胎数及临床妊娠率。结果 EMs患者GnRHa预治疗组降调后黄体生成激素(LH)、雌二醇(E2)水平低,人绒毛膜促性腺激素(hCG)日E_2值、获卵数及优质胚胎数最低,与对照组比较差异有统计学意义(F值分别为12.288、6.402、7.43、12.461和9.43,均P<0.05);Gn天数及Gn用量高于对照组,差异有统计学意义(F值分别为12.184、8.64,均P<0.05)。与GnRHa预治疗组比较,Oc预治疗组hCG日E_2值高及获卵数多,差异有统计学意义(F值分别为8.52、5.58,均P<0.05)。各组受精率、卵裂率、临床妊娠率差异无统计学意义(χ~2值分别为0.07、0.36和0.09,均P>0.05)。结论 EMs患者经GnRHa或Oc预治疗后都能获得相似的受精率、卵裂率和临床妊娠率,但Oc预治疗疗效肯定、不良反应轻微、价格低廉,成本效益优势明显,值得推广。
Objective To compare the clinical efficacy of in vitro fertilization-embryo transfer (IVF-ET) pretreatment with gonadotropin-releasing hormone agonist (GnRHa) and contraceptives (Oc) before infertility in women with endometriosis (EMs) effect. Methods Fifty-six cycles of EMs were divided into 35 cycles of GnRHa pretreatment group and 21 cycles of Oc pretreatment group. 49 cycles of simple tubal infertility patients were selected as the control group. The number of oocytes, fertilization rate, cleavage rate, number of high quality embryos and clinical pregnancy rate after pretreatment of Ems patients were compared. Results In the GnRHa pretreatment group, the levels of LH, E2 were low, the values of E_2 of human chorionic gonadotropin (hCG), the number of oocytes retrieved and the number of high quality embryos were the lowest in the GnRHa pretreatment group. Compared with the control (F = 12.288,6.402,7.43,12.461 and 9.43, all P <0.05). The days of Gn and the dosage of Gn were higher than those of the control group (F = 12.184, 8.64, all P <0.05). Compared with GnRHa pretreatment group, Oc pre-treatment group had higher E_2 values and more oocytes retrieved on the day of hCG, the difference was statistically significant (F value 8.52, 5.58, all P <0.05). There was no significant difference in fertilization rate, cleavage rate and clinical pregnancy rate between groups (χ ~ 2 values were 0.07,0.36 and 0.09, all P> 0.05). Conclusions Similar fertilization rate, cleavage rate and clinical pregnancy rate can all be obtained in patients with EMs after pretreatment with GnRHa or Oc. However, the efficacy of Oc pretreatment is affirmative with slight side effects, low cost and obvious cost benefit, which is worthy of promotion.