年龄、卵泡刺激素与黄体生成素比值对IVF妊娠结局的影响

Impact of female age and the ratio of basal FSH and LH level on clinical outcome of IVF-ET

目的:探讨年龄、基础卵泡刺激素(FSH)与黄体生成素(LH)比值对IVF/ICSI-ET妊娠结局的影响。方法:回顾性分析本中心自2006年1月～2007年3月行IVF-ET治疗的患者779例,按年龄分A、B、C 3组,A组:年龄≤30岁;B组:30岁<年龄≤35岁;C组:年龄>35岁,各组中再根据FSH/LH≥2分为两组,A1组:年龄≤30岁,FSH/LH<2,A2组:年龄≤30岁,FSH/LH≥2;B1组:30岁<年龄≤35岁,FSH/LH<2,B2组:30岁<年龄≤35岁,FSH/LH≥2,C1组:年龄>35岁,FSH/LH<2,C2组:年龄>35岁,FSH/LH≥2。比较3组间FSH/LH、促性腺激素(Gn)用量、获卵数、优质胚胎数、周期取消率和临床妊娠率及各组内FSH/LH对妊娠结局的影响。结果:A、B、C 3组中周期取消率分别为2.74%、3.45%、5.88%,临床妊娠率分别为40.8%、37.2%、28.6%,周期取消率和临床妊娠率A组与C组差异均有显著性(P<0.05);Gn用量、受精率A组与B、C两组差异均有显著性(P<0.05);获卵数、优质胚胎数3组间差异均有显著性(P<0.05)。FSH/LH值C组与A、B两组差异有显著性(P<0.05)。各组内FSH/LH≥2,获卵数差异有显著性(P<0.05),B1组和B2组优质胚胎数及冷冻胚胎数差异均有显著性(P<0.05),C1组和C2组周期取消率(2.98%vs5.77%)和临床妊娠率(37.3%vs17.3%)差异有显著性(P<0.05)。结论:年龄≤35岁,FSH/LH≥2时卵巢的反应性减退不明显,年龄>35岁,FSH/LH≥2时卵巢的反应性明显减退。FSH/LH≥2对行促超排卵治疗后卵巢反应性、周期取消可能性及IVF-ET结局有一定的预测价值。

Objective： To evaluate the impact of female age and the ratio of basal FSH and LH level on Clinical Outcome of IVF/ ICSI - ET cycles. Methods： Retrospectively analyzed 779 infertile women undergoing IVF/ICSI - ET treatment during the period of January 2006 to March 2007. All patients were divided into group A （ age≤〈30）, group B （30 〈 age≤35 ） and group C （ age 〉35） , then according to FSH/LH≥2, the three groups were divided into two groups, group A1 （ age≤30, FSH/LH 〈2 ）, group A2 （ age≤30, FSH/LH ≥2 ） ; group B1 （30 〈age≤35, FSH/LH 〈2 ） , group B2 （30 〈age≤35 , FSH/LH≥2 ） ; group C1 （ age〉35, FSH/LH〈2 ） , group C2 （ age 〉 35, FSH/LH ≥2） . IVF outcomes were analyzed. To compare the impact of the ratio of basal FSH and LH level on clinical outcome of IVF - ET in the same age. Results： Clinical pregnancy rates of group A, B and C were 40. 8%, 37.2%, and 28.6%, respectively. The Pregnancy rate of group A was significantly higher than those of group C （ P 〈 0. 05 ） . The rate of cancellation of group A, B and C were 2. 74%, 3.45%, and 5. 88% , respectively. The rate of cancellation of group C was significantly higher than those of group A （ P 〈 0. 05 ） . The number of oocytes retrievaled and high quality embryos were significantly differences between three groups （ P 〈 0. 05 ） . Dosage of gnnadotrephins of group A were significantly less than those of group B or C （ P 〈 0. 05） . The ratio of basal FSH and LH level of group C were significantly higher than those of group A or B （ P 〈 0. 05） . Patients with an elevated FSH/LH ratios （≥2） had fewer cocytes （P 〈0. 05） . The number of high quality embryos and freezing embryos were significantly differences between group Bland group B2 （P 〈0. 05） . The rate of cancellation and clinic pregnancy rate were significantly differences between group C1 （2. 98%, 37. 30% ） and group C2 （5.77%, 17. 30% ） （P 〈 0. 05 ） . Conclusion： When age ≤〈35, the impact of elevated FSH/LH ratios （≥12） on ovarian respouse is not obviously decreasing. When age 〉 35 the impact of elevated FSH/LH ratios （≥2） on ovarian response is obviously decreasing. The elevated FSH/LH ratios （≥2） may be used to predict the patients＇ovary response, the risk of cycle cancellation and the outcomes of IVF - ET.