早卵泡期长方案促性腺激素的调整用药对妊娠结局的影响

Clinical Outcome of Long-termRegimen of Gonadotropin Adjustment Medicationin Early Follicular Phase

目的探讨早卵泡期长方案促排卵过程中促性腺激素(Gn)的调整与妊娠结局的关系。方法回顾性分析2016年1月至2019年9月在我院行体外受精/卵泡浆单精子注射-胚胎移植(IVF/ICSI-ET)采用早卵泡期长方案促排卵2538个周期的临床资料,按照促排卵后第6天(D6)使用的促性腺激素的种类分为乐芮组374个周期、尿促性素(HMG)组1923个周期和未添加黄体生成素(LH)组241个周期。比较三组患者的优胚率、胚胎种植率、临床妊娠率等妊娠结局。结果三组患者男女双方年龄、受精方式、体重指数比较,差异有统计学意义(P<0.05),乐芮组女方年龄更大,补救ICSI更多,体重指数更高。三组患者Gn总量、Gn天数、HCG日血雌二醇(E_(2))值和LH值、获卵数和优质胚胎数都显著不同,乐芮组Gn总量更高、Gn天数更长;HCG日E_(2)值和LH值更低;获卵数和优质胚胎数均更少(P<0.01)。但妊娠率没有显著差别(P>0.05)。结论对于早卵泡期长方案促排卵过程中LH水平过度抑制(LH≤0.5U/L)的患者,可以添加LH,高龄、低反应患者添加重组LH有提高临床妊娠率的趋势,正常反应及高反应患者使用HMG替代重组LH也能提高临床妊娠率,也可减少OHSS的风险。

Objective To investigate the effect of adjustment of gonadotropin(Gn)on pregnancy outcome during long-term protocol ovulation induction in early follicular phase.Methods The clinical data of 2538 cyclesof vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)treatment in Nanchang Reproductive Hospital from January 2016 to September 2019 were retrospectively analyzed.According to the type of gonadotropin used on the 6th day(D6)after ovulation induction,the samples were divided into Lerui group(374 cycles),HMG group(1923 cycles)and LH group(241 cycles).The pregnancy outcomes such as good-quality embryo rate,embryo implantation rate and clinical pregnancy rate were compared among the three groups.Results There were significant differences in age of both genders,fertilization mode and body mass index in the three groups(P<0.05).The female in the Lerui group were older,had more rescue ICSI and higher body mass index.The total amount of Gn,Gn days,serum estradiol(E_(2))value and LH value on HCG day,the number of oocytes retrieved and the number of good-quality embryos were significantly different among the three groups.The total amount of Gn was higher and the number of Gn days was longer,the E_(2)value and LH value on HCG day were lower,and the number of oocytes and high-quality embryos were less in the Lerui group(P<0.01).However,there was no significant difference in pregnancy rate(P>0.05).Conclusion For patients with excessive inhibition of LH level(LH≤0.5U/L)during long-term protocol ovulation induction in early follicular phase,LH can be added.The addition of recombinant LH in elderly and low response patients canpossibly improve the clinical pregnancy rate.To replace LH with HMG in patients with normal and high response can also improve the clinical pregnancy rate and reduce the risk of OHSS.