促性腺激素释放素拮抗剂联合人重组促黄体激素对卵巢功能减退患者妊娠结局的影响

The effect of recombinant human luteinizing hormone supplementation on IVF/ICSI outcome in women with ovarian hypofunction——aretrospective study in the GnRH antagonist protocol

目的:研究重组人促黄体激素(r-hLH)在促性腺激素释放素(GnRH)拮抗剂促排卵方案中的应用指征。方法:回顾性分析2007年8月至2010年8月在本中心以GnRH拮抗剂方案促排卵的体外受精(IVF/ICSI)患者。卵巢功能减退纳入标准为卵泡刺激数(FSH)≥10U/L或窦卵泡数≤6个。研究分为两部分,第一部分纳入卵巢功能减退患者共107例,A组不添加r-hLH(n=80),B组添加r-hLH 75 U/d(n=27)。第二部分纳入应用GnRH拮抗剂+r-hLH+GnRH激动剂扳机的患者共71例并分为两组,C组为卵巢功能正常组(n=47),D组为卵巢功能减退组(n=24)。评价两组卵巢反应和妊娠结局的临床指标包括成熟卵子数、受精率、卵裂率、优质胚胎率、种植率和临床妊娠率。结果:①卵巢功能减退患者中,添加r-hLH组每优势卵泡平均雌激素水平、IVF成熟卵子数(100.00%vs 96.31%)显著高于对照组,种植率(29.41%vs 19.46%)和临床妊娠率(44.44%vs31.25%)均高于对照组,但差异无显著性。②添加了r-hLH的患者中,卵巢功能减退组IVF成熟卵子数(100.00%vs 93.71%)、IVF受精率(79.52%vs 38.46%)和ICSI受精率(84.85%vs 42.74%)显著高于卵巢功能正常组,种植率(28.89%vs 17.44%)、临床妊娠率(41.67%vs 25.53%)均高于卵巢功能正常组,但差异无显著性。结论:在GnRH拮抗剂方案中,添加r-hLH可以改善卵巢反应减退患者的卵巢反应和临床结局。卵巢功能正常者不是添加r-hLH的适应人群。

Objective： To study the indication of human recombinant luteinizing hormone（r-hLH） in GnRH antagonist protocol.Methods： Retrospective analysis.All the patients using GnRH antagonist protocol were enrolled in this study from Aug,2008 to Aug,2010.This study was divided into two parts.① The first part enrolled 107 patients with ovarian hypofunction（FSH≥10U/L or antral follicle count≤6）,80 of them without supplementation of r-hLH（group A）,27 of them received r-hLH together with GnRH antagonist（group B）.② The second part enrolled 71 patients using r-hLH supplementation and GnRH agonist triggering,47 of them had normal ovary function（group C）,and 24 of them had ovarian hypofunction（group D）.The outcomes include mature oocytes rate,fertilization rate,cleavage rate,high-quality embryo rate,biomedical pregnancy rate,implantation rate and clinical pregnancy rate.Results： ① In group B,implantation rate（29.41% vs 19.46%） and clinical pregnancy rate（44.44% vs 31.25%） were higher than group A,but there were no statistical significance.IVF mature oocytes rate and E2/≥14mm follicle of group A was significantly higher than group B.② In group D,IVF mature oocytes rate（100.00% vs 93.71%）,IVF fertilization rate（79.52% vs 38.46%） and ICSI fertilization rate（84.85% vs 42.74%） were significantly higher than group C.In group D,implantation rate（28.89% vs 17.44%） and clinical pregnancy rate（41.67% vs 25.53%） were higher than group C,but there were no statistical significance.Conclusions： Recombinant human luteinizing hormone supplementation to GnRH antagonist protocol can improve ovary response and pregnancy outcome of ovarian hypofunction women.There has no reason for women with normal ovary function to add r-LH in GnRH antagonist protocol.