目的 探讨3种不同助孕方案在≥40岁妇女体外受精-胚胎移植（IVF-ET）周期中的临床效果。 方法 回顾性分析2010年8月－2012年2月期间，于四川大学华西第二医院生殖中心行IVF-ET助孕、年龄≥40岁妇女共245个周期的临床资料，排除一侧卵巢缺如患者3例，余242个周期根据助孕方案不同分为3组：拮抗剂组（GnRH-A方案组）44个周期、长方案组109个周期及短方案组89个周期，比较3种方式助孕的临床效果。 结果 3组均无早发黄体生成素峰；长方案组应用促性腺激素（Gn）的时间最长，应用Gn数量最多，获得最高的获卵数及获胚数（P＜0.05）；3组的受精率、优胚率、冷冻胚胎数、周期取消率、卵巢过度刺激综合征发生率、早期流产率均无统计学意义（P＞0.05），短方案组的种植率及临床妊娠率最低（P＜0.05）。 结论 GnRH-a长方案在≥40岁妇女的IVF-ET周期中具有较好的临床结局，在≥40岁妇女IVF-ET周期中具有与长方案相似的结局，并且可以减少Gn使用量，提高卵泡及胚胎质量，短方案组对≥40岁妇女临床效果较差。
【摘要】 目的 探讨绝经期促性腺激素及氯米芬在促排卵治疗中适宜的治疗方法。 方法 2004年8月〖CD3/5〗2008年5月对80例不孕患者实施促排卵治疗。测定血雌激素、黄体生成素水平、阴道B型超声、子宫颈黏液评分及基础体温测定监测排卵,并观察不良反应的发生情况。 结果 使用氯米芬及绝经期促性腺激素排卵率分别为773%和856%；卵巢过度刺激综合症发生率为150%,大多由使用绝经期促性腺激素方案引起,且起始剂量150 U；未破裂卵泡黄素化综合征的发生率为90%。 结论 绝经期促性腺激素和氯米芬治疗排卵障碍性不孕有较好的疗效,绝经期促性腺激素和氯米芬促排卵治疗效果与卵巢的状态及激素水平有关。促性腺激素的使用应强调个体化,以达到较好的治疗效果并降低卵巢过度刺激综合症的发生。【Abstract】 Objective To explore the proper method with human menopausal gonadotropin and clomiphene in facilitating ovulation treatment. Methods Eighty infertility patients with the facilitating ovulation treatment were included from August 2004 to May 2008. Ovulation monitoring was based on the level of estrogen and luteinizing hormone, transvaginal B ultrasound, the cervical Inlser score and assay of basal body temperature. Besides, adverse reactions were observed. Results The rates of ovulation of clomiphene and human menopausal gonadotropin were 77.3% and 85.6%. The rate of ovarian hyperstimulation syndrome (OHSS), which was mostly caused by human menopausal gonadotropin with 150 IU, was 150%. The rate of luteinized unruptured follicle syndrome (LUFS) was 90%. Conclusion Individual therapy with human menopausal gonadotropin and clomiphene is essential to infertility patients with ovulation barrier. The efficacy of human menopausal gonadotropin and clomiphene is relevant to the ovarian condition and the hormone levels. Individual using of hormone is important in the facilitating ovulation treatment, which is helpful to increase the effective efficacy and prevent the OHSS.
ObjectiveTo compare the clinical outcomes of different pituitary down regulation protocols with gonadotropin-releasing hormone agonist (GnRH-a) in patients undergoing in vitro fertilization and embryo transfer (IVF-ET) treatment. MethodsThe clinical data of 358 IVF cycles in women at 40 years old or younger from November 2012 to January 2013 in the West China Second University Hospital were analyzed retrospectively. All the 358 cycles were divided into two groups, according to whether the leading follicle diameter was <14 mm (group A, 158 cycles) or ≥14 mm (group B, 200 cycles) after discontinuing the GnRH-a. The clinical outcomes were compared between the two groups. ResultsCompared with group B, the amount of gonadotropins used was significantly more, and the time of gonadotropin use was also significantly longer in group A (P<0.05). However, the serum level of estradiol (E2), progesterone (P) and Luteinizing hormone (LH), incidence of premature P rise, retrieved ovum number, the rates of implantation, clinical pregnancy, miscarriage and live birth did not significantly differ between the two groups (P>0.05). ConclusionDiscontinuing the use of GnRH-a in early stage of controlled ovarian stimulation can keep effective pituitary down regulation and it has the same optimal clinical outcomes in patients undergoing IVF-ET.
ObjectiveTo research on the clinical efficacy of gonadotropin releasing hormone (GnRH) pump in the treatment of hypogonadotropic hypogonadism (HH) by using micropulse pump subcutaneous pump Gonadorelin to treat patients with HH. MethodsThrough the report of one case of GnRH pump treatment patient and related literature review, we studied the effect of GnRH pump therapy and the traditional treatment on HH patients' sex hormone level, secondary sexual characteristics, spermatogenesis and pregnancy rate. ResultsThrough treatment, GnRH pump effectively improved the patient's sex hormone level, secondary sexual characteristics development and sperm production ability, and eventually the patient attained the goal of fertility. The patient had a change in his voice tone; Beard and armpit hair grew out; The patient had a good mood with sexual drive; luteotropic hormone, follicle-stimulating hormone and testosterone became normal. The patient's sperm density was 20×109/L, and the average sperm motility was higher than 30%. ConclusionPulse pump GnRH conforms to the physiological rhythm of GnRH secretion with a good clinical efficacy and tolerance. So we recommend GnRH pump as the preferential choice for treatment of hypogonadotropic hypogonadism.
ObjectiveTo systematically review the effectiveness and safety of laparoscopy with postoperative gonadotropin releasing hormone agonist (GnRH-a) versus laparoscopy alone for endometriosis. MethodsRandomized controlled trials (RCTs) on laparoscopy with postopertative GnRH-a versus laparoscopy alone in treatment of endometriosis were retrieved in the following databases:the Cochrane Library (Issue 3, 2013), PubMed, EMbase, WanFang Data, CNKI, and CBM from inception to February, 2013. According to the inclusion and exclusion criteria, the literature were screened, the data was extracted and the methodological quality of the included studies was also assessed by two reviewers independently. Then, meta-analysis was performed using RevMan 5.1.7 software. ResultsA total of 15 RCTs involving 1 761 patients were included. There were statistically significant differences between the laparoscopy with postoperative GnRH-a group and the laparoscopy alone group in the following 4 aspects:the symptom relief rate (RR=1.24, 95%CI 1.16 to 1.33, P < 0.000 01), the recurrence of lesion (RR=0.35, 95%CI 0.24 to 0.51, P < 0.000 01), the recurrence of pain (RR=0.70, 95%CI 0.53 to 0.92, P=0.01), and the pregnancy rate (RR=1.43, 95%CI 1.25 to 1.65, P < 0.000 01). ConclusionLaparoscopy postoperative GnRH-a for endometriosis can enhance the symptom relief rate, reduce the recurrence of lesion and the recurrence of pain, and increase the pregnancy rate. But because of the limitation of the quality of the included studies and publication bias, the above conclusion should be verified by conducting more high quality RCTs.
Objective To summarize the progress of effect of gonadotropin-releasing hormone agonist on protecting ovarian function of young breast cancer patients who received chemotherapy, and to provide reference for clinical work. Methods Through searching of PubMed, CNKI, WanFang database, and other databases, we mainly collected relevant literatures in nearly five years, which concerning the effect of gonadotropin-releasing hormone agonist on protecting the ovarian function of young breast cancer patients who received chemotherapy. Results Young breast cancer patients faced with problems about long-term survival, quality of life, social psychological pressure, and other related problems. Chemotherapy caused irreversible damage to the ovarian function. Chemotherapy combind with gonadotropin-releasing hormone agonist could prevent premature ovarian failure and improve patients’ quality of life. Conclusions Gonadotropin-releasing hormone agonist combines with chemotherapy can protect the ovarian function of young breast cancer patients, and reduce premature ovarian failure and retain reproductive function with no serious adverse effect. In addition, it shall not affect the curative effect of chemotherapy itself, but this conclusion still needs further randomized controlled clinical trial to confirm.