控制性超排卵中血清促黄体生成素浓度过低对体外受精-胚胎移植的影响

Excessive LH Suppression During Controlled Ovarian Hyperstimulation the Influence of on Vitro Fertilization-embryo Transfer Outcome

目的 :探讨控制性超排卵中血清促黄体生成素 (L H)浓度过低对体外受精 -胚胎移植的影响。方法 :为 2 0 0 0年 6月至 2 0 0 1年 8月在本所接受体外受精 (IVF)或卵母细胞单精子显微注射 (ICSI)助孕的不孕症患者 ,对其中具有正常促性腺激素功能的妇女 16 0例采用促性腺激素释放激素激动剂 (Gn RH- a)长方案并单纯用人基因重组促卵泡生长素 (r- FSH)进行控制性超排卵 (COH) ,以注射绒毛膜促性腺激素 (HCG)日血清 L H浓度分为两组 ,低 L H组为血清 L H≤ 0 .5 m IU/ml,对照组为血清 L H>0 .5 m IU/ml,其中低 L H组 72个周期 ,占 4 5 % ,对照组 88个周期 ,总共 16 0个周期。按本所常规方法过行 IVF/ICSI。我们对这 16 0例临床资料进行回顾性分析。结果 :低 L H组平均 r- FSH用药量和用药时间明显多于对照组 (30 .2 1± 8.12支与 2 7.17± 7.99支 ,10 .93± 1.2 5 d与 10 .0 2± 1.18d,P<0 .0 1) ;r- FSH刺激第 8天的血清 L H浓度和雌二醇 (E2 )浓度 (2 .0 5± 1.4 9m IU/ml与 2 .6 2± 1.5 8m IU/ml,182 7.3± 897.6 pg/ml与 2 0 93.3±92 3.7pg/ml,P<0 .0 5 )、注射 HCG日血清 L H浓度和 E2 浓度 (0 .15± 0 .16 m IU/ml与 1.6 0± 0 .92 m IU/ml,1916 .8±989.5 pg/ml与 3495 .2± 938.2 pg/ml,P<0 .0 0 1)?

Objectives:To determine whether excessive LH suppression during controlled ovarian hyperstimulation influence in vitro fertilization embryo transfer(IVF ET)outcome.Methods: Retrospective analyzed the outcome of 160 infertile normogonadotropic women couples that performed IVF/ICSI(intracytoplasmic sperm injection)treatment during the period of June 2000 to August 2001.All of them accepted Gonadotropin releasing hormone agonist(GnRH a)down regulation and ovarian stimulation with recombinant follicle stimulating hormone(r FSH).A threshold value serum LH of 0.5 mIU/ml on the day of human chorionic gonadotropin(HCG) administration was applied.There are 72 cycles in low LH group with serum LH≤0.5 mIU/ml and 88 cycles in control group with serum LH>0.5 mIU/ml.Results: Low LH group were stimulated in a longer period,required more r FSH ampoules than control group(10.93±1.25 d vs 10.02±1.18 d and 30.21±8.12 Amps vs 27.17±7 99 Amps, P <0.01,respectively).The levels of serum E 2,LH on the stimulated day 8 and the day of HCG administration were less in low LH group compared with control(1827.3±897.6 pg/ml vs 2093.3±923.7 pg/ml,2.05±1.49mIU/ml vs 2.62±1.58mIU/ml, P <0.01;1916.8±989.5 pg/ml vs 3495.2±938.2 pg/ml,0.15±0.16mIU/ml vs 1.60±0.92 mIU/ml, P <0.001,respectively).The mean serum LH concentration from stimulated day 5 to HCG administration were also lower in low LH group compare with control(1.25±0.57 mIU/ml vs 1.93±0.73 mIU/ml, P <0.01).Fertilization rates were less in low LH group compareal with control group(82.9% vs 89.9%,83.3% vs 90.2%, P <0.001,respctively).Biochemical pregnancy loss rate were higher in low LH group than in control group( 28.6% vs 11.8%, P <0.05).There were no statistically difference between two groups in the number of oocytes retrieved,metaphase of second meiosis oocytes,embryo cleaved rate,high quality embryos formed rate,implantation rate,biochemical pregnancy rate,clinical pregnancy rate and clinical pregnancy loss rate( P >0.05).Conclusion: Excessive LH suppression during controlled ovarian hyperstimulation when using GnRH a down regulation and ovarian stimulating with r FSH alone may interfere with the pace of follicular development,decease fertilization rate and increase the risk of early pregnancy loss.