卵巢反应正常者卵泡中晚期添加黄体生成素对体外受精-胚胎移植结局影响研究

Effects of LH supplementation in the middle and late follicle phases on the outcome of in vitro fertilizationembryo transfer in normal response patients

目的 探讨卵巢反应正常者超促排卵过程中添加黄体生成素（LH）对体外受精-胚胎移植（IVF-ET）结局的影响。方法 回顾性分析2014年1月至2016年1月汕头市中心医院生殖中心接受IVF-ET治疗的360例卵巢反应正常的不孕患者的临床资料,研究对象均于月经第3～5天行重组人促卵泡激素（r-FSH）促超排卵,当卵泡最大直径达14 mm时,按LH水平分为3组,1组：LH〈1 U/L,2组：1 U/L≤LH〈2 U/L,3组：LH≥2 U/L。每组再分为A组：继续使用r-FSH至人绒毛膜促性腺激素（HCG）注射日;B组：每日添加人绝经期促性腺激素（HMG）;C组：每日添加r-LH。比较各组的临床结局。结果 3组中不添加LH的A组中A1组的促性腺激素（Gn）时间,r-FSH用量,流产率高于A2、A3组;妊娠率A1、A2低于A3组,差异有统计学意义（P〈0.05）。小组内A1组促性腺激素r-FSH用量、Gn时间、流产率显著高于B1、C1组,受精率及妊娠率显著低于B1、C1组,差异有统计学意义（P〈0.05）;A1、B1、C1组3组间添加LH日及HCG日血清LH水平、获卵数差异均无统计学意义（P〉0.05）。A2组妊娠率显著低于B2、C2组,r-FSH用量、Gn时间、获卵数、流产率、添加LH日及HCG日血清LH水平差异均无统计学意义（P〉0.05）。A3、B3、C3组间各项指标差异均无统计学意义（P〉0.05）。结论 对卵巢反应正常者,降调时LH水平过低影响临床结局;卵泡中晚期在LH〈2 U/L时添加r-LH可提高妊娠率,尤其血清LH〈1 U/L时添加r-LH可获较好的临床结局,LH≥2 U/L时不能从添加r-LH中获益。在相同LH水平时添加HMG和r-LH疗效无差异。

Objective To explore the effects of LH supplementation on the outcome of normal response women undergoing in vitro fertilization-embryo transfer（IVF-ET）. Methods The data of 360 IVF-ET cycles in Center of Clinical Reproductive Medicine, Affliated Shantou Central Hospital from 2014.1 to 2016.1 were analyzed retrospectively.All cases underwent long down-regulation protocol with gonadotropin releasing hormone agonis in the mid-luteal phase,and trolled ovarian stimulation was carried out with follicle stimulation hormone （r-FSH） on the days 3 - 5 of the menstrual cycle. When a dominant follicle reached a diameter of 14mm, based on the LH levels, the cases were divided into：group one, LH 〈 1 U/L; group two, 1 U/L≤LH 〈 2 U/L;group three,LH≥2 U/L. According to the project of LH supplementation, each group were sub-divided into subgroups ： group A, without supplementation of r-hLH ; group B, with supplementation of HMG; guoup C, with supplementation of r-hLH.Clinieal outcomes of all groups were analyzed and compared. Results The durations and doses of gonadotropin （Gn） and abortion rates were higher, while the rates of pregnancy were lower in group A1 than those in group A2 and group A3 （P 〈 0.05）.The durations and doses of gonadotropin and abortion rates were higher, while the rates of pregnancy were lower in group A1 than that in group B1 and group C1 （P 〈 0.05）.There was no significant difference in serum LH concentrations on the days of HMG and HCG administration or the rates of fertilization between group A 1, group B 1 and group C 1 （P〉0.05）.The rate of fertilization was significantly lower in group A2 compared with group B2 and group C2 （P〈 0.05）.There was no significant difference in the durations and doses of gonadotropin or serum LH concentrations on the days of HMG and HCG administration or the rates of pregnancy and abortion rates between group A2, group B2 and group C2 （P〉0.05）.There was no significant difference in every clinical outcomes between group A3, group B3 and group C3 （P〉0.05）. Conclusions For normal response patiens, too low LH will result in worse clinical outcomes.When the serum LH level is lower than 2 U/L, especially lower than 1 U/L, LH supplementation in the middle and late follicle phases during IVF can obtain higher pregnancy rate and lower abortion rate.The patients with serum LH≥2 U/L can not benefit from r-LH supplementation. Under the same r-LH level, there is no difference in clinical outcome between supplementation of HMG and supplementation of r-LH.