生长激素在卵巢低反应患者中的应用研究

An application research of growth hormone on poor ovarian response patients in controlled ovarian hyperstimulation

目的探讨生长激素对控制性超排卵中卵巢反应低下的患者的应用价值。方法将38例符合卵巢反应低下的不孕症患者,随机分为生长激素组(21例)和对照组(17例),均采用短方案降调节,其中生长激素组从周期第2～3 d每天注射4IU生长激素直至HCG日,比较两组超排卵过程及结局。结果两组的一般情况无明显差异;两组超排过程中的各项参数,包括各时期内分泌结果、促性腺激素的使用时间、剂量、获卵数、受精率、卵裂率、优质胚胎率以及移植胚胎数目均无显著性差异,最终GH组获得了42.1%的临床妊娠率,而对照组仅为13.3%。两组中,超排周期第二天血清GH、抑制素、IGF-Ⅰ、IGF-Ⅱ及IGFBP3水平均无显著差异;超排周期第6天两组患者的抑制素水平无显著差异;注射HCG日中,GH组血清IGF-Ⅰ水平较对照组显著增加(P<0.000);IGF-Ⅱ水平在两组间无显著差异;GH组血清IGFBP3水平较对照组显著下降(P<0.000);两组患者卵泡液中IGF-Ⅰ、IGF-Ⅱ及IGFBP3水平均无显著差异。结论在卵巢低反应患者中,在促排过程中加用生长激素可以显著提高血中IGF-Ⅰ水平,降低IGFBP3水平,妊娠率有上升趋势。

【Objective】To investigate the application value of GH to the patients with poor ovarian response in COH.【Methods】38 infertility patients with ovarian poor response were divided into GH group（n =21） and control group（n =17） in random.Each cycle was used down-regulation short protocol,the patients in GH group were administrated GH 4 IU everyday from the day 2～3.The processe of controlled ovarian hyperstimulation and outcome were compared.【Results】There was no significant difference in the general data.The stimulation date、include the hormone result at any time,the dose of Gn and stimulate time、number of oocytes retrieved fetilization rates,embryos cleavage rates,good-quality embryo rates and the mean number of embryo transfer for every group.Finally,the pregnancy rate was 42.1% in growth hormone group,while it was 13.3% in control group only.In the two groups,there was no significant difference in the level of serum GH,inhibinB,IGF-Ⅰ,IGF-Ⅱand IGFBP3 in D2;there was no significant difference in the level of inhibinB in D6;Compared with control group,the level of serum IGF-Ⅰ in the day of hCG was significant higher in GH group（P〈 0.000）;the level of serum IGFBP3 in the day of hCG was significant lower in GH group（P〈 0.000）;While there was no significant difference in the level of serum IGF-Ⅱon the day of hCG;There was no significant difference in the level of follicular fluid IGF-Ⅰ,IGF-Ⅱ and IGFBP3 between the two groups.【Conclusions】In patients with poor ovarian response,combined with growth hormone during the controlled ovatian hyperstimulation will significantly improve the IGF-Ⅰof level of blood decrease the level of IGFBP3,the pregnancy rate is on the rise