生长激素在体外受精-胚胎移植卵巢反应不良患者中的应用

Growth hormone co-treatment in poor responders undergoing IVF-ET

目的探讨生长激素(GH)在卵巢反应不良患者体外受精-胚胎移植(IVF-ET)中的作用及其机制。方法2008年9月至2009年4月拟再次行IVF-ET治疗的卵巢反应不良患者(既往周期Gn启动量≥225IUqd,获卵数≤5个)共53例,其中GH组26例,对照组27例。GH组从Gn启动前一天或当日开始合用GH至人绒毛膜促性腺激素(HCG)注射日。取卵日收集卵泡液测定GH、胰岛素样生长因子-1(IGF-1)、雌二醇(E2)水平,RT-PCR半定量检测颗粒细胞类固醇合成快速调节蛋白(StAR mRNA)表达。结果GH组患者自身对照结果显示:HCG日E2水平、获卵数、MⅡ卵子数、受精率、移植胚胎数和可用胚胎数均显著增加,促性腺激素释放激素激动剂(GnRH-a)用量减少(P<0.05)。GH组与对照组相比移植胚胎数、可用胚胎数和卵泡液IGF-1水平显著增高(P<0.05);临床妊娠率和卵泡液GH、E2、颗粒细胞StAR mRNA水平均提高(P>0.05)。结论合用GH可改善卵巢反应不良患者IVF-ET结局,其机制与提高卵泡液IGF-1水平,改善卵子、胚胎质量有关。

Objective To evaluate the efficacy and the mechanism of growth hormone （GH） co- treatment in poor responders undergoing IVF-ET. Methods Total 53 patients who had a prior poor ovarian response （≤5 oocytes at ovum pick up） to high dose Gn （initial dose≥225 IU per day） were recruited in this study. GH group of 26 patients were given GH along with Gn daily until the HCG administration day. Control group of 27 patients received the same treatment protocol except the GH co-treatment. Follicular fluid was collected on ovum-pick-up day for assaying the GH, IGF-1 and E2 level, and StAR mRNA level in granulosa cells by reverse transcription-potymerase chain raction （RT-PCR）. Results Compare to the previous cycle,GnRH-a dose in GH cycles decreased, the E2 level on I-ICG administration day, number of oocytes retrieved, number of MII oocytes, fertilization rate, number of embryos transferred and number of embryos available increased significantly（ P 〈0. 05 ）. The number of embryos transferred, number of embryos available and IGF-1 level in follicular fluid were significantly higher in GH group than in control group; the clinical pregnancy rate, GH and E2 level in follicular fluid, StAR mRNA levels in granulosa ceils of GH group increased without statistical significance （ P 〉0. 05 ）. Conclusions GH co-treatment in poor responders could improve the outcome of IVF-ET,which imply that GH may improve the quality of oocytes and embryos related to the elevated IGF-1 level in follicular fluid.