重组人黄体生成素能改善改良超长方案多囊卵巢综合征患者IVF/ICSI妊娠结局

Recombinant human LH improves IVF/ICSI outcome of modified supper long protocol in patients with PCOS

目的探究在多囊卵巢综合征(PCOS)患者行改良超长方案促排卵治疗中应用重组人黄体生成素(r-hLH)对体外受精-胚胎移植/卵胞浆内单精子注射(IVF-ET/ICSI)妊娠结局的影响。方法回顾性分析2011年4月至2012年4月在我院行改良超长方案促排卵第8天(D8)血清黄体生成素(LH)<0.5U/L的414例PCOS患者。实验组(n=342)为自D8添加r-hLH 75U者,而对照组(n=72)为未添加r-hLH者。对比两组主要妊娠结局,如:注射人绒毛膜促性腺激素(HCG)日LH、雌二醇(E2)、孕酮(P)水平、雌孕激素比值(P/E2)、子宫内膜厚度,平均获卵数、受精率、优胚率、着床率、妊娠率、重度卵巢过度刺激综合征(OHSS)发生率、抱婴率及流产率等。结果与对照组相比,实验组HCG日P/E2明显下降[(0.2±0.1)vs.(0.4±0.3),P=0.027],HCG日LH水平[(1.2±0.4)U/L vs.(0.4±0.1)U/L,P<0.001]、子宫内膜厚度[(12.4±2.2)mm vs.(11.7±2.6)mm,P=0.002]、受精率[(82.0±18.4)%vs.(75.1±21.2)%,P=0.005]、优胚率[(71.1±22.1)%vs.(64.8±23.7)%,P=0.034]等均明显增加,平均获卵数明显下降[(13.0±6.0)个vs.(15.6±6.6)个,P=0.001],HCG日E2(1 0657.6±4 929.1)pmol/L vs.(10 404.8±4 783.4)pmol/L,P=0.714]、着床率(53.2%vs.48.4%,P=0.326)、妊娠率(76.1%vs.67.2%,P=0.143)、重度OHSS发生率(1.5%vs.0%,P=0.592)、抱婴率(66.0%vs.59.0%,P=0.296)及流产率(6.9%vs.7.3%,P=1.0)等虽无统计学差异,但均有改善趋势。结论研究结果提示,r-hLH或许能改善改良超长方案PCOS患者IVF/ICSI妊娠结局。

Objective： To investigate the impact of applying recombinant stimulation on pregnancy outcome in modified supper long protocol syndrome（PCOS） undergone IVF/ICSI. human LH （r-hLH） in ovarian in patients with polycystic ovary Methods： The data of 414 PCOS patients with low LH level（〈0.5 U/L）at the 8th day of ovarian stimulation during IVF/ICSI in our reproductive medical center from Apr. 2011 to Apr. 2012 were retrospectively analyzed. The patients in experimental group （n= 342）were additionally given rhLH from the 8th day of ovarian stimulation to the day of HCG injection（HCG day）,and the patients in control group （n= 72）were not given the rhLH. The LH, E2, progesterone（P） levels, the P/E2 ratio and the endometrial thickness on HCG day, number of oocytes retrieved, fertilization rate, high quality embryos rate, implantation rate, clinical pregnancy rate, severe ovarian hyperstimulation syndrome（OHSS） rate, live birth rate and miscarriage rate were compared between the two groups. Results： The P/E2 ratio[（0.2±0.1）vs. （0.4±0.3）,P=0.027] on the HCG day and number of oocytes retrieved[（13.0 ± 6.0）vs. （15.6± 6.6）, P = 0. 001] were significantly decreased in experimental group. The LH levels [ （ 1.2 ±0.4） U/L vs. （0.4 ± 0.1 ） U/L, P =0.001 ）, endometrial thickness [ （ 12.4 ± 2.2）mm vs. （11.7±2.6）mm,P=0. 002）on HCG day,the fertilization rate[（82.0±18.4）% vs. （75. 1±21.2）%,P=0. 005] and high quality embryos rate（71.1±22.1）% vs. （64.8±23.7）%,P=0. 034]were significantly increased in experimental group. Although there were no significant differences in E2 levels on HCG day [（10 657.6±4 929.1） pmol/L vs. （10 404.8±4 783.4）pmol/L,P=0. 714],implantation rate （53.2% vs. 48.4%,P=0.326）,clinicalpregnancyrate（76.1% vs. 67. 2% ,P=0.143） ,severe OHSS rate （1.5% vs. 0%,P=0.592）,live birth rate（66.0% vs. 59.0%,P=0.296）and miscarriage rate（6. 9% vs. 7.3%,P=1. 0）between the two groups,there was the trend of improvement. Conclusions. The rhLH improves pregnancy outcome of modified supper long protocol in patients with PCOS undergone IVF/ICSI.