超长降调节方案超排启动日血清LH水平对卵巢膜异位囊肿患者IVF—ET结局的影响

The effect of serum LH level on the day of superovulation start on the prolonged gonadotropin-releasing hormone agonist therapy on the outcomes of IVF-ET in patients with ovarian endometriosis cysts

目的探讨超长降调节方案超排启动日血清LH水平对卵巢内膜异位囊肿患者体外受精-胚胎移植（IVF—ET）结局的影响。方法75例卵巢内膜异位囊肿患者在腹腔镜或开腹下行囊肿剥出术或经阴道B超引导下囊肿穿刺术后每28d注射促性腺激素释放激素激动剂（GnRH．d）共3—4次，末次注射后14—84d予促性腺激素（Gn）超排卵行IVF—ET治疗，按超排启动日血清LH水平分为两组，A组30例，LH〈0．5IU／L，B组45例，0．5IU／L≤LH〈1．5IU／L，比较两组患者IVF．ET结局的差异。结果A组使用Gn的总量[（32．28±7．7）支]及人类绝经期促性腺激素（hMG）的用量[（12．0±8．9）支]多于B组[（25．84±7．1）支，（6．19±7．4）支]，胚胎植入率低于B组[A组18．1％VSB组26．7％]，差异均有统计学意义（P〈0．05）。结论超长降调节方案超排卵启动日血清LH水平过低将增加IVF—ET治疗中Gn用量，降低胚胎植入率，LH水平应作为超排启动的主要参考指标。

Objective To evaluate the effect of serum LH level on the day of superovulation start on the prolonged gonadotropin-releasing hormone agonist therapy on the outcomes of in vitro fertilization and embryo transfer （IVF-ET） in patents with ovarian endometriomas. Methods 75 patients with ovarian endometriomas were treated by laparoscopic cystectomy or laparotomy cystectomy or ultrasound-mediated cysts puncture, and gonadotropin-releasing hormone agonist （GnRH-α） was given for 3 to 4 times every 28 days after the operation. Superovulation started after 14 ± 84 days of the last injection. All the patients were divided into two groups according to the level of serum LH. Group A included 30 patients whose level of LH was less than 0. 5IU/L, and group B included 45 patients whose level of LH was over 0. 5IU/L and less than 1.5IU/L. The outcomes of IvF-ET were evaluated. Results The total ampoules of Gn administration and the ampoules of hMG needed in group A [ （ 32. 28 ±7.7 ） ampoules, （ 12.0 ± 8.9 ） ampoules, ] were sig nificantly more than that in group B [ （25.84 ± 7. 1 ）ampoules, （6. 19 ± 7.4）ampoules, P 〈 0. 05 ]. The successful embryo implantation rate in group A（ 18. 1% ） was lower than group B（26. 7% ）, and the difference has statistical significance （ P 〈 0.05）. Conclusion The low level of serum LH on the superovulation day on the prolonged gonadotropin-releasing hormone agonist protocol will increase the ampoules of Gn administration and decrease the successful embryo implantation rate of IVF-ET, thus LH should be a more important reference parameter of superovulation start.