112例基础黄体生成激素<2 IU/L患者行降调节长方案体外受精结局分析

IVF Outcome of Long Down-Regulation Protocol in 112 Patients with Luteinizing Hormone <2 IU/L

目的:了解基础黄体生成激素(LH)<2 IU/L患者行长方案体外受精/胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)的卵巢反应性及助孕结局,探讨其作为单项指标与卵巢储备功能的相关性。方法:选择2014年1月—2017年3月在安徽医科大学附属省立医院行IVF/ICSI-ET且基础卵泡刺激素(FSH)<10 IU/L的患者。根据患者年龄和LH水平分为4组,即A组:年龄≤35岁[25~35岁,平均年龄(28.86±3.10)岁],LH<2 IU/L,88例;B组:年龄≤35岁[25~35岁,平均年龄(28.48±3.72)岁],LH 2~5 IU/L,226例;C组:年龄>35岁[36~42岁,平均年龄(38.54±2.84)岁],LH<2 IU/L,24例;D组:年龄>35岁[36~42岁,平均年龄(37.64±2.40)岁],LH 2~5 IU/L,58例。对4组的超促排卵、胚胎数量和质量以及妊娠率相关数据进行比较。结果:A组基础日、降调日和促性腺激素(Gn)启动日LH水平低于B组,差异均有统计学意义(P<0.05);A组Gn总量较B组增加但差异无统计学意义(P>0.05);人绒毛膜促性腺激素(hCG)日E_2水平、直径大于14 mm的卵泡数、获卵数、2原核(PN)胚胎数、优质胚胎数均低于B组,差异有统计学意义(P<0.05)。A组的FSH/LH均值为4.06。C组基础日、降调日和Gn启动日LH水平低于D组,差异均有统计学意义(P<0.05);C组Gn总量较D组增加但差异无统计学意义(P>0.05);C组h CG日E2水平、直径>14 mm的卵泡数、获卵数、2PN胚胎数、优质胚胎数与D组比较,差异无统计学意义(P>0.05)。C组的FSH/LH均值为4.23。A组与B组比较、C组与D组比较,h CG日LH水平、生化妊娠率和临床妊娠率差异均无统计学意义(P>0.05)。结论:年龄≤35岁且基础LH<2 IU/L,可以反映卵巢储备功能的状态并指导超排卵方案的选择。

Objective:To study the ovarian response and IVF/ICSI-ET outcome of the long GnRH-a protocol in those patients with base LH<2 IU/L,so as to explore the correlation of LH as a single index and ovarian reserve.Methods:Those patients undergoing IVF/ICSI-ET with the base FSH<10 IU/L from January 2014 to March 2017 were enrolled.According to the age and the base LH level,those patients were divided into four groups,the group A:age≤35 years[25~35 years old,the average age(28.86±3.10)]and base LH<2 IU/L(n=88);the group B:age≤35 years[25~35 years old,the average age(28.48±3.72)]and base LH 2~5 IU/L(n=226);the group C:age>35 years[36~42 years old,the average age(38.54±2.84)]and base LH<2 IU/L(n=24);the group D:age>35 years[36~42 years old,the average age(37.64±2.40)]and base LH 2~5 IU/L(n=58).The superovulation rate,the quantity and quality of embryo,and the pregnancy rate were compared.Results:The base LH level and LH levels on the down-regulated day and Gn starting day in the group A were significantly lower than those in the group B(P<0.05),while the total dose of Gn in the group A was higher than the group B(However,P>0.05).The E2 level on the day of hCG injection,the number of≥14 mm follicles,the retrieved oocyte number,the number of 2PN and the number of high quality embryos in the group A were significantly lower than those in the group B(all P<0.05).The FSH/LH ratio in the group A was 4.06.The base LH level and LH levels on the down-regulated day and Gn starting day in the group C were significantly lower than those in the group D(P<0.05),while the total dose of Gn in the group C was higher(However,P>0.05).There were no significant differences in the E2 level on the day of hCG injection,the number of≥14 mm follicles,the retrieved oocyte number,the number of 2PN and the number of high quality between the group A and group B(all P>0.05).The FSH/LH ratio in the group C was 4.23.Interestingly,there were no significantly differences in the LH level on the day of hCG injection,the rate of biochemical pregnancy and the rate of clinical pregnancy between the group A and group B,or between the group C and group D(both P>0.05).Conclusions:The age≤35 and base LH<2 IU/L,as two parameters of ovarian reserve function,can be used as clinical references of ovarian stimulation protocols.