长方案超促排卵过程中LH变化趋势对IVF/ICSI-ET结局的影响

Effect of serum LH variation on clinical outcome in women undergoing IVF/ICSI-ET with standard long protocols

目的:探讨控制性超促排卵(COH)周期中LH变化趋势对体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)结局的影响。方法:回顾性分析228个IVF/ICSI长方案周期,1按h CG注射日与降调节后Gn启动前血清LH水平的变化趋势,分为降低趋势组和升高趋势组;2将升高趋势组及降低趋势组根据COH中期与降调节后LH水平变化趋势分为A组和B组(升高趋势中的降低组和升高组),C组和D组(降低趋势中的降低组和升高组);3按照LH降低幅度将A组和C组分为A1组(下降幅度<50%)和A2组(下降幅度≥50%)、C1组(下降幅度<50%)和C2组(下降幅度≥50%),比较各组IVF/ICS-ET结局的差异。结果:1降低趋势组与升高趋势组获卵数、胚胎数、总的受精率、卵裂率、可利用胚胎率、优质胚胎率比较,差异均无统计学意义(P>0.05),而胚胎种植率(26.09%vs 35.22%,P<0.05)、临床妊娠率(45.11%vs 58.67%,P<0.05)显著较升高趋势组低,早期流产率较升高组略高(26.08%vs 15.91%),但差异无统计学意义(P>0.05)。2A组与B组、C组与D组相比较IVF/ICSI结局均无统计学差异。3 A1组、A2组的受精率、临床妊娠率、胚胎种植率、可利用胚胎率组间比较,差异均无统计学意义,但优质胚胎率A1组较高(65.48%vs40.68%,P<0.05);C1组、C2组IVF/ICSI结局相比无统计学差异。结论:IVF/ICSI-ET长方案,h CG注射日较Gn启动前血清LH升高,有助于提高胚胎种植率、临床妊娠率,且在COH中期LH下降幅度<50%,能显著提高优质胚胎率。故在COH的过程中适时添加LH,选择合适的血清LH水平启动COH,有助于改善助孕结局。

Objective： To investigate the relationship between the LH variation and outcome of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer （IVF/ICSI-ET） during the controlled ovarian hyperstimu- lation （COH） process. Methods： This retrospective analysis collected 228 WF/ICSI cycles and grouped as following： 1） according to the LH variation pattern on the day of injecting hCG and the initial day of Gn stimulation after putuitary down-regulation, all the enrolled cycles were divided into the decreased group and increased group; 2） the decreased group and increased group were respectively divided into group A decreased subgroup and group B increased subgroup, group C decreased subgroup and group D increased subgroup according to the LH variation pattern on the mid- follicular phase during the COH and initial day of Gn stimulation after putuitary down-regulation; 3） according to the decrease amplitude of LH in group A and group C, these two groups can be respectively divided into： group A1 （〈50%） and group A2 （≥ 50%）, group C1 （〈50%） and group C2 （≥ 50%）. Results： 1） Compared with the decreased group, the embryo implantation rate （26.09% vs 35.22%, P〈0.05） and the clinical pregnancy rate （45.11% vs 58.67%, P〈 0.05） were significantly higher than those in increased group. 2） In contrast, there was no significant difference between groups A and B, C and D in all clinical outcome. 3） The high-quality embryo rate of group A1 was significantly higher than that in group A2 （65.48% vs 40.68 %, P〈0.05）. Nodifference was found between group C1 and group C2. Conclusion： Therefore, in the process of COH, the appropriate choice of serum LH level for stimulate ovulation is important for improving pregnancy outcome in WF cycles.