长方案卵泡中/后期添加含活性LH的不同促性腺激素制剂的临床结局比较

Comparison of the clinical outcomes of supplementation with different Gn(different LH preparations) in the middle-and late-follicular phase in the standard long down-regulation protocol

目的:探索经典长方案卵泡中/后期添加含活性黄体生成素(LH)的不同促性腺激素(Gn)制剂后行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的最佳用药方案。方法:回顾性分析采用长方案行IVF/ICSI的1 441个周期患者的临床资料,根据中/后期所添加的Gn制剂不同,分为3组,A组为重组LH(r-LH)组,B组为人绝经期促性腺激素(h MG)组,C组为高纯h MG(HP-h MG)组。比较3组患者的Gn使用总量、Gn使用天数、获卵数、优质胚胎数、顶级优质胚胎数、临床妊娠率、活产率、早期流产率等。结果:C组Gn使用天数显著低于A组及B组,B组Gn使用总量显著高于A组及C组,A组和C组双原核(2PN)数、卵裂数、优质胚胎数、可利用胚胎数显著高于B组(P<0.05),但A组与C组比较无统计学差异(P>0.05);C组的顶级优质胚胎数高于A组及B组,差异有统计学意义(P<0.05)。种植率A组为44.0%,B组为38.2%,C组为42.5%,各组间无统计学差异(P>0.05)。临床妊娠率和活产率A组为62.5%和50.6%,B组为59.8%和44.0%,C组为65.3%和52.3%,A组和C组高于B组,但各组间比较无统计学差异(P>0.05);早期流产率各组间相似。结论:长方案卵泡中后期添加LH制剂可获得较好的临床结局,但添加HP-h MG与r-LH可以减少Gn使用天数和总量,增加顶级优质胚胎数,临床妊娠率和活产率有增高的趋势,总体临床结局均优于国产h MG。

Objective： To compare the impact of supplementation with different luteinizing hormone （LH） preparations in the middle- and late-follicular phase of ovarian stimulation on clinical outcomes in the standard gonadotropin releasing hormone agonist （GnRH-a） long protocol and to explore the optimized treatment method. Methods： Retrospective analysis was performed on clinical data of 1 441 in vitro fertilization/intracytoplasma sperm injection-embryo transfer （IVF/ICSI-ET） cycles. Patients were divided into three groups according to the supple- mentation of different LH preparations. Patients of group A were added with recormbinant LH （r-LH）, group B were added with human menopausal gonadotropin （hMG） and group C were added with high pure （HP-hMG）. Clinical outcomes of the three groups, including the amount of gonadotropin （Gn）, duration of Gn stimulation, the number of oocytes retrieved, high-quality embryos and top-quality embryos, clinical pregnancy rate, live birth rate, early abortion rate, etc. were analyzed. Results： The duration of Gn stimulation was much fewer in group C than in group A and group B, and the total dosage of Gn used was much higher in group B than in group A and group C. The number of cleavage, good-quality embryos and vailable embryos in group A was significantly higher than that in group B, but there was no statistical difference between group A and group C. The number of top-quality embryos in group C was significantly higher than that in the other two groups. The implantation rate was 44.0% in group A, 38.2% in group B and 42.5% in group C, the clinical pregnancy rate and the live birth rate were 62.5% and 50.6% in group A, 59.8% and 44.0% in group B, 65.3% and 52.3% in group C, respectively, but there was no statistical significance. The early abortion rate was similar in three groups. Conclusion： LH preparations supplemented in the middle- and late-follicular phase in the standard long down-regulation protocol obtains good clinical outcomes. The clinical outcomes of HP-hMG and r-LH supplemented were better than that of hMG, which not only reduced the duration and doses of Gn used, but also increased the number of top-quality embryos, and there was an increasing tendency in clinical pregnancy rate and live birth rate.