补充黄体生成素对控制性超促排卵过程中卵巢慢反应患者临床结局的影响

Effect of LH supplementation during COH on clinical outcome in patients with slow responders

目的：评价控制性超促排卵（COH）过程中卵巢慢反应患者补充重组黄体生成素（rLH）或人绝经期促性素（HMG）的有效性。方法：选取行长方案体外受精（IVF）或卵胞浆内单精子注射（ICSI）治疗的患者101例,均给予重组卵泡刺激素（rFSH）。将COH第7～8天血清黄体生成素（LH）持续正常者作为对照组（A组,n=34）;将LH水平持续较低者随机分为两组,补充HMG组（B组,n=34）或rLH组（C组,n=33）。比较3组患者的临床结局。结果：B组患者的COH天数及rFSH用量均显著低于A组和C组（P〈0.05）;C组的HCG日雌二醇（E2）水平、获卵数及双原核（2PN）受精率显著高于A组和B组（P〈0.05）。3组的促性腺激素（Gn）用量、HCG日LH、孕酮（P）、优质胚胎率及临床妊娠率比较,差异均无统计学意义（P〉0.05）。结论：对COH过程中卵巢慢反应的患者,补充HMG可减少COH天数及rFSH用量,降低治疗费用;补充rLH可改善卵巢的反应性,提高HCG日E2水平,增加获卵数及受精率,改善妊娠结局。

Objective： To evaluate the effect of recombinant luteinizing hormone （rLH） or human menopausal gonadotropin（HMG） supplementation during controlled ovulation hyperstimulation（COH） in patients with slow responders. Methods： One hundred and one patients treated with in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI） were administered by rFSH and divided into three groups according to serum luteinizing hormone （LH） level during the seventh or eighth days after COH. The control group（group A,n=34） ,the HMG group（group B ,n=34） and the rLH group （group C, n = 33 ）. The clinical outcome in the three groups were compared. Results： Compared with days of COH and the amount of rFSH, group B was significant- ly lower than that of group A and group C （P〈0.05）. Estradiol （ E2 ） level, number of oocytes and retrieved 2PN fertilization rate of group C were statistically significant higher than that of group A and group B （P〈0.05）. There were no statistical differences in gonadotropin （Gn） con- sumption, serum LH level and progesterone（P） on the day of HCG injection ,high quality embryo rate and clinical pregnancy rate （P〉0.05）. Conclusions： HMG supplementation could decrease the dose of rFSH and the days of COH, and reduce the cost of treatment, rLH supplementation could improve the response of the ovary, E2 level and the number of oocytes retrieved, fertilization rate ,and then IVF outcome in patients with slow responders.