短方案超促排卵后卵泡晚期黄体生成激素对体外受精结局影响的研究

Effect of concentration of serum luteinizing hormone in late follicle phase on the outcome of in vitro fertilization after superovulation by short-term protocol

目的探讨在超促排卵时卵泡晚期血清黄体生成激素(LH)对体外受精结局的影响。方法回顾性分析2006年5月至10月在北京大学第三医院基础促性腺激素正常的不孕症妇女,212个体外受精-胚胎移植(IVF-ET)周期,均采用超促排卵方案促性腺激素释放激素激动剂(GnRH-a)短方案降调节方案,卵泡刺激素(FSH)225IU/d起进行超促排卵患者,人绒毛膜促性腺激素(HCG)日血清LH水平对IVF妊娠结局的影响。结果HCG日血清LH≥1·58IU/L者妊娠率(58·33%)明显高于LH<1·58IU/L者(34·48%),比较低LH组(A组)和高LH组(B组)的临床情况发现,A组的Gn用量高(2218·5IU对1938·0IU)、Gn使用时间长(12·32d对11·03d),HCG日的雌二醇(12854·96pmol/L对15022·55pmol/L)、孕酮(3·12nmol/L对3·69nmol/L)水平低,经统计学处理,P均<0·01。结论在超促排卵过程中,卵泡晚期的LH水平过低(<1·58IU/L)将会导致临床妊娠率下降,可能与获卵数多,而相应的雌、孕激素水平较低有关。

Objective To evaluate the effect of sersum luteinizing hormone （LH） level in late follicle phase on the outcome of in vitro fertilization （IVF）. Methods From May 2006 to Oct. 2006 the outcome of 212 infertile normal gonado- tropic women in Peking University Third Hospital who were performed IVF/ICSI （intracytoplasmic sperm injection） treatment on was retrospectively analyzed. The protocol of controlled ovarian hyperstimulation was short-term protocol. The aim was to test the relationship between the IVF outcome and the serum LH level of HCG Day. Fertilization, pregnancy, and spontaneous abortion rates were also evaluated according to a threshold value serum LH of 1.58 IU/L, group A （LH 〈 1.58 IU/L） and B （ LH≥ 1.58 IU/L ）, Results The clinical pregnancy rate of B group was significantly higher than A group. The total dosage of Gn and days to achieve stimulation in A group were significantly more than B group （P 〈 0. 01 ）. The estradiol and progesterone levels on the day of HCG administration in A group were significantly lower than B group. The number of oocytes retrieved in A group was significantly more than B group. The fertilization rate and high-quality embryos rate between the two groups ware similar in statistics. The multiple birth rate and spontaneous abortion between two groups ware similar in statistics. Conclusion Low endogenous LH concentrations （ 〈 1.58IU/L） in the late follicular phase of an IVF cycle are associated with significantly lower clinical pregnancy rate. It may be associated with more oocytes harvesting and lower E2 and P level.