重组人黄体生成素在体外受精-胚胎移植超促排卵周期中的临床应用分析

Analysis on clinical application of recombinant human luteinizing hormone for controlled ovarian hyperstimulation cycles in in vitro fertilization-embryo transfer

目的:评价体外受精-胚胎移植(IVF-ET)超促排卵周期中卵泡晚期增加人绝经期促性腺激素(HMG)用量,同时补充重组人黄体生成素(r-hLH),对主要实验室指标和临床妊娠结局的影响。方法:选择行IVF-ET或卵胞浆内单精子显微注射(ICSI)技术助孕治疗的患者212例,采用标准长方案垂体降调节,根据超促排卵的卵泡晚期血清黄体生成素(LH)水平将所有病例分为两组:血清LH水平持续较低补充r-hLH者72例设为实验组(r-hLH组),血清LH水平持续正常未补充r-hLH者140例设为对照组(非r-hLH组),比较两组患者的年龄、基础内分泌状态、促性腺激素(Gn)使用时间及使用量、人绒毛膜促性腺激素(HCG)注射日各项内分泌激素值、获卵数、两组不同助孕方式的双原核(2PN)受精率、优质胚胎率、移植周期的着床率及临床妊娠率。结果:两组患者的年龄、基础LH、基础卵泡刺激素(FSH)、基础雌二醇(E2)水平、超促排卵天数、Gn总量、IVF/ICSI助孕的2PN受精率、移植周期的着床率、临床妊娠率差异均无统计学意义(P>0.05)。r-hLH组超促排卵FSH总量低于非r-hLH组,差异有统计学意义(P<0.05);r-hLH组HMG总量高于非r-hLH组,差异有统计学意义(P<0.05);HCG注射日r-hLH组血清LH水平低于非r-hLH组,差异有统计学意义(P<0.05);r-hLH组的优质胚胎率高于非r-hLH组,差异有统计学意义(P<0.05)。结论:激动剂标准长方案超促排卵周期卵泡晚期血清LH水平持续较低者增加HMG的用量,适量补充r-hLH可提升卵子成熟度,显著提高优质胚胎率,一定程度改善IVF/ICSI的助孕结局。

Objective：To evaluate the dose of human menopausal gonadotropin（HMG） added during late follicular phase in controlled ovarian hyperstimulation（COH） cycles of in vitro fertilization-embryo transfer（IVF-ET）,and analyze the effect of recombinant human luteinizing hormone（r-hLH） supplement on main laboratory indexes and clinical pregnancy outcome.Methods：A total of two hundred and twelve patients treated with IVF-ET or intracytoplasmic sperm injection（ICSI） were selected,pituitary down-regulation standard long protocol was adopted,then all the patients were divided into two groups according to serum LH level during late follicular phase： experimental group（including seventy-two patients treated with r-hLH） and control group（including one hundred and forty patients treated without r-hLH）;the indexes in the two groups were compared,including age,basic endocrine state,application time and dose of gonadotropin,endocrine hormones levels on the day of human chorionic gonadotropin（HCG） injection,the number of retrieved oocytes,2PN fertilization rate,high quality embryo rate,implantation rate,and clinical pregnancy rate.Results：There was no statistically significant difference in age,levels of basic LH,basic follicle stimulating hormone（FSH）,and basic estradiol,days of COH,total dose of gonadotropin,2PN fertilization rate,implantation rate,and clinical pregnancy rate between experimental group and control group（P0.05）.The total level of FSH in experimental group was statistically significantly lower than that in control group（P0.05）;the total level of HMG in experimental group was statistically significantly higher than that in control group（P0.05）;the level of serum LH on the day of HCG injection in experimental group was statistically significantly lower than that in control group（P0.05）;the high quality embryo rate in experimental group was statistically significantly higher than that in control group（P0.05）.Conclusion：For the patients with persistent low serum LH level during late follicular phase of COH cycles,increasing the dose of HMG and adding r-hLH reasonably can improve maturity of oocytes and significantly increase high quality embryo rate,which can improve the pregnancy outcome of patients receiving IVF/ICSI to a certain degree.