基础状态血清高黄体生成素水平及黄体生成素/卵泡刺激素比值对多囊卵巢综合征患者体外受精妊娠结局的影响

Effect of basal serum luteinizing hormone and luteinizing hormone/follicle-stimulating hormone ratio on outcomes of in vitro fertilization-embryo transfer in patients with polycystic ovarian syndrome

目的探讨基础状态高血清黄体生成素(LH)、不同黄体生成素/卵泡刺激素比值(LH/FSH)对多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析我中心接受IVF治疗的134个PCOS助孕周期,按照基础状态LH≤10 U/L分为A(1LH≤10 U/L)、A(2LH>10 U/L)组,按照LH/FSH<2分为B(1LH/FSH<2)、B(2LH/FSH≥2)组。分别比较A、B组患者一般情况、胚胎质量和临床妊娠结局。结果 A2组血清FSH、T、LH/FSH比值、获卵数均较A1组高,有统计学差异(P<0.05);但两组在窦卵泡计数(AFC)、降调时间、Gn天数、启动日LH、LH/FSH、胚胎质量及临床妊娠结局方面均无统计学差异。B2组的基础LH、HCG日E2、获卵数较B1组高,但Gn使用剂量较少,有统计学差异(P<0.05);而两组在降调节时间、Gn天数、启动日LH、LH/FSH比值、临床妊娠结局方面无统计学差异。结论 PCOS患者经口服避孕药物预处理后,基础状态高LH水平(LH>10 IU/L)及高LH/FSH比值(LH/FSH≥2)对其IVF妊娠结局无不良影响。

Objective To evaluate the effect of basal serum luteinizing hormone （LH） and luteinizing hormone/ follicle-stimulating hormone （LH/FSH） ratio on the clinical outcomes of in vitro fertilization-embryo transfer （IVF-ET） in patients with polycystic ovary syndrome （PCOS）. Methods A retrospective analysis was performed of 134 IVF cycles in patients with PCOS. The cycles were classified into 2 groups according to serum levels of LH and also into 2 groups according to LH/FSH ratio, namely group A1（LH ≤ 10 IU/L）, group A2 （LH〉10 IU/L）, group B1 （LH/FSH ratio〈2）, and group B2 （LH/FSH ratio≥2）. The clinical characteristics, embryological data and pregnancy outcomes were compared between the groups. Results Patients in group A2 showed significantly higher FSH, T level, and LH/FSH ratio with a greater number of oocytes retrieved than those in group A1, but the time for down-regulation, duration of stimulation, AFC, LH and LH/FSH on the first day of stimulation, embryological data and pregnancy outcomes did not differ significantly between the two groups. Compared with group B1, group B2 showed higher basal LH, E2 level on the day of HCG, more oocytes retrieved and lower dose of gonadotropins used, but the time for down-regulation, duration of stimulation, LH and LH/FSH on the first day of stimulation and pregnancy outcomes were comparable between the two groups. Conclusion A high basal LH level or a high LH/FSH ratio does not produce obvious deleterious effect on the clinical outcomes of IVF-ET in women with PCOS who take oral contraceptives for pretreatment before long GnRH-agonist protocol.