国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2019, Vol. 38 ›› Issue (1): 35-42.

• 论著 • 上一篇    下一篇

GnRHa超长方案对不同分期子宫内膜异位症患者IVF/ICSI-ET结局影响的Meta分析

李欣欣，张奥，全松   

  1. 510515 广州，南方医科大学南方医院妇产科生殖医学中心
  • 收稿日期:2018-08-30 修回日期:2018-09-24 出版日期:2019-01-15 发布日期:2019-01-15
  • 通讯作者: 全松，E-mail：quansong@smu.edu.cn E-mail:quansong@smu.edu.cn

Effect of GnRHa Ultra Long Protocol on Clinical Outcomes of IVF/ICSI-ET in Patients with Different Stages of Endometriosis: A Meta-Analysis

LI Xin -xin，ZHANG Ao，QUAN Song   

  1. Reproductive Medical Center，Department of Obstetrics and Gynecology，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China
  • Received:2018-08-30 Revised:2018-09-24 Published:2019-01-15 Online:2019-01-15
  • Contact: QUAN Song，E-mail：quansong@smu.edu.cn E-mail:quansong@smu.edu.cn

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摘要： 目的：通过Meta分析综合评价促性腺激素释放激素激动剂（GnRHa）超长方案是否能改善不同分期子宫内膜异位症（EMs）患者体外受精/胞浆内单精子注射-胚胎移植（IVF/ICSI-ET）助孕结局。方法：检索PubMed、EMBASE、Web of Science、Cochrane Library、中国知网（CNKI）、万方全文数据库、维普中文科技期刊数据库、中国生物医学文献数据库和Google学术搜索等，并辅以手工检索。纳入2018年8月1日前公开发表的关于GnRHa超长方案及长方案对EMs患者IVF/ICSI-ET结局影响的临床研究。由2名研究者提取数据进行Meta分析。结果：共纳入9篇文献。与长方案相比，Ⅰ～Ⅱ期EMs患者使用超长方案的促性腺激素（Gn）用量较大（SMD=0.36，95%CI：0.01～0.70，P＜0.05）、获卵数较少（SMD=-0.26，95%CI：-0.48～-0.04，P＜0.05），但着床率较高（RR=1.19，95%CI：1.04～1.37，P＜0.05），基础卵泡刺激素（FSH）、Gn天数、临床妊娠率差异无统计学意义（均P＞0.05）；Ⅲ～Ⅳ期患者使用超长方案的临床妊娠率较高（RR=1.38，95%CI：1.06～1.80，P＜0.05），基础FSH、Gn天数、Gn用量、获卵数、着床率差异无统计学意义（均P＞0.05）。结论：超长方案不能明显改善Ⅰ～Ⅱ期EMs患者的妊娠率，且Gn用量较大、获卵数较少；但超长方案可明显改善Ⅲ～Ⅳ期EMs患者的妊娠率。

关键词: 子宫内膜异位症, 排卵诱导, 受精, 体外, 精子注射, 细胞质内, 胚胎移植, Meta分析

Abstract: Objective：To evaluate the effect of GnRHa ultra long protocol on clinical outcomes of IVF/ICSI-ET in patients with different stages of endometriosis. Methods：PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, Wanfang Data, VIP database, CBM and Google Scholar were searched to identify those studies involving human subjects published before August 1st, 2018. Those clinical trials that compared the effects of the GnRHa ultra long protocol and the GnRHa long protocol on clinical outcomes of IVF/ICSI-ET in patients with endometriosis were included. The meta-analysis was performed by two investigators. Results：Nine studies were included in the meta-analysis. Comparing with the GnRHa long protocol, the GnRHa ultral long protocol in those endometriosis patients at stage Ⅰ-Ⅱ had significantly higher Gn doses (SMD=0.36, 95%CI： 0.01-0.70) and higher implantation rate (RR=1.19, 95%CI: 1.04-1.37), and lower number of oocytes retrieved (SMD=-0.26, 95%CI: -0.48- -0.04), although there were no significant differences in basal FSH, Gn days and clinical pregnancy rate (all P＞0.05). In those endometriosis patients at stage Ⅲ-Ⅳ, the GnRHa ultra long protocol had significantly higher clinical pregnancy rate (RR=1.38, 95%CI: 1.06-1.80) when compared with the GnRHa long protocol, although there were no significantly differences in basal FSH, Gn doses, Gn days, the number of oocytes retrieved and implantation rate (all P＞0.05). Conclusions：For those endometriosis patients at stage Ⅰ-Ⅱ, the GnRHa ultra long protocol could not improve the pregnancy rate, but cost more Gn and retrieve fewer oocytes. For those endometriosis patients at stage Ⅲ-Ⅳ, the GnRHa ultra long protocol could significantly improve the pregnancy rate.

Key words: Endometriosis, Ovulation induction, Fertilization in vitro, Sperm injections, intracytoplasmic, Embryo transfer, Meta-analysis