长方案促排卵中期添加黄体生成素对助孕结局的影响

Effects of LH Supplementation in GnRH-agonist Long Protocol

目的:探讨GnRHa长方案促排卵中期LH水平为0.5～ 1.5 IU/L的患者外源性LH添加与否对其助孕结局的影响。方法:回顾性分析首次接受体外受精(IVF)或卵胞质内单精子注射(ICSI)助孕治疗、采用经典长方案、单用rFSH促排卵且在卵泡晚期血清黄体生成素(LH)水平在0.5～ 1.5 IU/L之间的患者199例,根据是否添加LH的情况分为3组,A组无添加(n=64),B组添加hMG(n=83),C组添加rLH(n=52)。分析3组对象的临床结局。结果:3组患者促排中期E2水平两两比较,A组>B组>C组,组间差异具有统计学意义(P<0.01);hCG注射日E2水平两两比较,B组>C组>A组,组间差异具有统计学意义(P=0.00);LH水平两两比较,C组>B组>A组,组间差异具有统计学意义(P=0.00);3组受精率分别为87.6%、68.4%和76.4%,差异有统计学意义(P=0.000);正常受精率分别为75.4%、62.1%和68.6%,组间具有显著差异(P=0.00);取消移植率分别为0.0%、14.5%和11.5%,差异显著(P<0.05)。3组间促性腺激素(Gn)使用天数、Gn使用总量、获卵数、成熟卵子数、优质胚胎率以及其他妊娠结局相关指标均无统计学差异(P>0.05)。结论:长方案促排卵中期LH水平在0.5～ 1.5 IU/L范围之间时无需添加外源性LH制剂,若添加外源性LH(包括hMG、rLH)会降低受精率以及正常受精率,增加移植取消率及OHSS发生率的风险。

Objective：To evaluate the effect of exogenous LH supplementation in patients receiving ovarian stimulation in GnRH-agonist protocol with the concentration of serum LH ranging from 0.5 IU/L to 1.5 IU/L during the intermediate phase of folliculogenesis.Methods：A retrospective analysis was been conducted on 199 normogonadotropic infertile patients who underwent their first IVF/ICSI cycle.Patients treated with recombined FSH following GnRH-agonist suppression with serum LH concentration ranging from 0.5 IU/L to 1.5 IU/L during the intermediate phase of folliculogenesis were divided into 3 groups：group A without any LH supplementation,group B supplemented with hMG and group C supplemented with rLH.Results：There were no significant differences in the basic clinical features of patients among three groups（P 0.05）.There was a statistical difference in the serum E2 level during the intermediate phase of folliculogenesis between each two groups.Serum LH levels（CBA） and E2（BCA） levels on the day of hCG injection were statistically different（P=0.00）.In group A,group B and group C,fertilization rates were 87.6%,68.4% and 76.4%,respectively with significant differences（P=0.00）,normal fertilization rates were 75.4%,62.1% and 68.6% with significant differences（P=0.00）.There were no statistical differences among these groups in the total Gn consumption,the number of oocytes retrieved,the number of second meiosis oocytes,high-quality embryo formation rate or other related indicators of pregnancy outcome.Conclusion：Exogenous LH supplementation is not needed when serum LH concentration during the mid-follicle phase ranges 0.5-1.5 IU/L.Endogenous LH is sufficient to ensure the oocyte development and embryo quality.Adding exogenous LH will reduce the fertilization and normal fertilization rate,decrease clinical pregnancy rate and increase the financial burden for patients.Meanwhile,adding hMG will conceivably increase the risk of ovarian hyper-stimulation syndrome（OHSS） and cause higher cancellation rate in the fresh transfer cycles.