采用长方案控制超排卵中HCG日LH水平与妊娠结局的关系

The Effect of Serum LH Levels on Pregnancy Outcome in Women Undergoing IVF with Long Protocols

目的探讨患者行IVF-ET经垂体降调节后,注射HCG日血清LH水平与妊娠结局的关系。方法回顾性收集行IVF-ET长方案助孕274个周期的资料,分析HCG日血清LH水平与Gn用量及妊娠的关系。结果 ROC曲线显示HCG日血清与IVF临床妊娠率存在着明显的相关性;HCG注射日血清LH≤1.05IU/L者妊娠率(37.7%)明显低于LH>1.05IU/L者(52.5%);其Gn用药剂量增加(P<0.001)和Gn用药天数延长(P<0.003);优质胚胎获得率、种植率和临床妊娠率低(P<0.05);早期流产率高(P<0.05);组间HCG日血清E2水平、获卵数、受精率、卵裂率比较差异无统计学意义(P>0.05)。结论长方案COH中HCG日血清LH≤1.05IU/L会引起垂体的过度抑制,增加Gn剂量及延长Gn天数,将会导致种植率、临床妊娠率下降和早期流产率增高。

Objective The aims of this study were to assess the effect of serum LH levels on pregnancy outcome in women undergoing IVF with long protocols. Methods A retrospective study that included 274 cycles was preformed in this study.Serum LH levels were measured on the day of HCG administration.Results The receiver operating characteristic(ROC) analysis was used to explore the influence of serum LH levels and Gonadotrophin doses to pregnancy results.It showed that there was a significant correlation between serum LH levels on the day of HCG administration and pregnancy rates.Compared with group with more than 1.05 IU/ml serum LH levels,the group with less than 1.05 IU/ml serum LH levels revealed a significantly lower pregnancy rate(37.7% vs 52.5%,P<0.001).Meanwhile,the higher doses of Gn,the longer days of stimulation were observed.Consequently,good embryo rates,implantation rates,clinical pregnancy rates decreased significantly,and early abortion rate increased.Other parameters including E2 concentrations on the day of HCG administration,the numbers of retrieval oocytes,fertilization rates,cleavage rates presented no statistical difference.Conclusion During long protocol,the LH levels with less than 1.05 IU/ml on the day of HCG administration implied that the hypothalamus was suppressed excessively,it would lead to the lower pregnancy and implantation rate and higher early abortion rate.