长方案促排卵过程中血清LH低于正常值时补充LH对助孕结局的影响

Effect of Exogenous LH Supplementation in GnRH-agonist Long Protocol on IVF Outcomes in the Patients with Subnormal Serum LH

目的探讨在体外受精-胚胎移植(IVF-ET)周期长方案促排卵过程中晚卵泡期血清促黄体生成素(LH)低于正常值时,补充基因重组人黄体生成素(r-hLH)或人绝经期尿促性腺激素(HMG)对IVF-ET助孕结局的影响。方法采用回顾性分析,选择因女方输卵管因素行IVF-ET助孕的患者529例,所有患者均采用标准长方案,单用基因重组促卵泡激素(rFSH)促排卵。根据年龄、晚卵泡期血清LH、是否补充外源性LH将所有患者分成6组:<35岁的A组血清LH>1.2mU/mL,单用rFSH促排46例,B组血清LH<1.2mU/mL,补充r-hLH 52例,C组血清LH<1.2mU/mL,补充HMG 257例;≥35岁的D组血清LH>1.2mU/mL,单用rFSH促排34例,E组血清LH<1.2mU/mL,补充rhLH 41例,F组血清LH<1.2mU/mL,补充HMG 99例。结果 <35岁的3组患者之间和≥35岁的3组患者之间在年龄、不孕年限、BMI,基础FSH、LH、E2水平,Gn使用天数、Gn用量,HCG日LH、P水平,HCG日内膜厚度及获卵数等方面差异均无统计学意义(均P>0.05)。B组及E组rFSH总量分别高于C组及F组,差异有统计学意义(均P<0.05);B组及F组E2水平及2PN受精率分别明显高于A组及D组,差异有统计学意义(均P<0.05);A、B、C组之间优质胚胎率及妊娠率比较差异无统计学意义(均P>0.05);E组优质胚胎率及妊娠率明显高于D组,差异有统计学意义(均P<0.05)。结论口服避孕药降调长方案晚卵泡期血LH值<1.2mU/mL时,适量添加r-hLH可以改善卵子质量,提高受精率,改善妊娠结局,尤其是明显提高≥35岁患者的临床妊娠率、受精率及优胚率。

Objective To evaluate the effect of supplementation with recombinant human luteinizing hormone（r-hLH）or human menopausal gonadatropin（HMG）on in vitro fertilization-embryo transfer（IVF-ET）outcomes in patients with the serum LH concentration lower than 1.2 mU/mL in gonadotropin-releasing hormone（GnRH）-agonist long protocol. Methods Clinical data of 529 patients who underwent IVF-ET due to tube-peritoneal factors were retrospectively analyzed. All patients were given long luteal phase protocols with rFSH used for controlled ovarian hyperstimulation（COH）. They were divided into 6 groups according to age,serum LH concentration in late follicular phase and exogenous LH supplementation：group A,in which 46 patients at age of〈35 years had serum LH〉1. 2 mU/mL and had no LH supplementation;group B,in which 52 patients with their age less than 35 years old had serum LH〈1. 2 mU/mL and were supplemented with r-hLH;group C,in which 257 patients less than 35 years old had serum LH〈1. 2 mU/mL and were supplemented with HMG;group D,in which 34 patients at age of ≥35 years did not receive any LH supplementation with their serum LH〉1. 2 mU/mL;group E,in which 41 patients at age of ≥35 years had serum LH〈1. 2 mU/mL and were supplemented with r-hLH;group F,in which 99 patients with their age ≥35 years old and serum LH〈1.2 mU/mL were administered with HMG. Results There were no statistical differences between %35 years old groups（group A,B,C）and ≥35 years old groups（group D,E,F）in age,duration of infertility,BMI,lev els of basic FSH, LH, and estradiol（E2 ）, days of usage of Gn, total dose of Gn, levels of LH, progesterone（P）and endometrial thickness on the day of HCG,and the number of oocytes retrieved（P〉0.05）. The total doses of rFSH was statistically signifi cantly higher in group B and group E than in group C and group F（P〈0.05）. The E2 levels and 2PN fertilization rate was statistically significantly higher in group B and group F than in group A and group D（P〈0.05）. There were no statistical differences among group A,B,and C in high quality embryo formation rate and pregnancy rate（P〉0.05）. The high-quality embryo formation rate and pregnancy rate in group E was significantly higher than in group D（P〈0.05）. Conclusion r-hLH supple-mentation can improve the quality of oocytes, increase the fertilization rate, and improve the pregnancy outcomes of patients with low serum LH level（LH〈l. 2 mU/mL）in late follicular phase in GnRH-agonist long protocol. It significantly increases the clinical pregnancy rate,fertilization rate and high-quality embryo formation rate in patients equal to or greater than 35 years old.