重组生长激素应用于IVF前次失败患者的初步探讨

A pilot study of recombinant growth hormone used in patients with previous IVF failure

目的观察生长激素(GH)预处理对患者临床妊娠结局的影响,探讨GH对胚胎质量的改善情况。方法选取2015年1月至2016年5月在我中心行IVF助孕治疗、前一周期因无可用胚胎或胚胎质量差助孕失败的36例患者为研究对象。前一周期(自身对照周期)采用我中心常规促排方案(长方案或拮抗剂方案)进行,移植后未获得临床妊娠;第2周期(GH周期)促排前进行约4~6周的GH预处理后再次促排卵,促排卵期间GH维持原剂量持续至HCG日,取卵后行常规IVF或ICSI。比较前后两次促排卵周期的促排情况、获卵数、受精率、胚胎发育情况及临床妊娠率等。结果患者前后两次促排卵Gn用药总量、促排卵天数、HCG日子宫内膜厚度、获卵数及取消周期率比较均无显著性差异(P>0.05)。GH周期中HCG日孕酮(P)水平[(3.31±1.46)nmol/L]显著低于自身对照周期[(2.51±1.14)nmol/L](P<0.05)。前后两次促排卵周期的受精率、无可移植胚胎比例比较无显著性差异(P>0.05);GH周期的正常受精率(67.48%vs.53.50%)、可用胚胎率(72.04%vs.38.26%)、优胚率(30.11%vs.15.44%)及临床妊娠率(43.48%vs.0)均显著高于自身对照周期(P<0.05)。结论助孕治疗过程中,对于前一周期因胚胎质量不佳导致助孕失败的患者,在诱导排卵前给予GH预处理可以使部分患者的胚胎质量得到改善,提高临床妊娠率。但其具体机制及应用效果尚需更进一步的研究深入探讨。

Objective:To explore the effect of pretreatment with growth hormone(GH)on improvement of embryos quality in patients with previous IVF failure.Methods:Thirty six patients who had pregnancy failure due to no available embryo or poor quality of embryo in the previous cycle with long program or antagonist program were included in this study in Northwest Women's and Children's Hospital ART center from January 2015 to May 2016.The patients were received GH pretreatment for 4to 6weeks before ovulation induction,and continuously administrated with initial dose of GH to HCG day during the ovulation period,finally received the routine IVF or ICSI procedure after oocyte retrieval in the second cycle.The number of oocytes retrieved,fertilization rate,embryonic development and clinical pregnancy rate were compared between the two groups.Results:There were no significant differences in the total doses of gonadotropin(Gn),the days of ovulation induction,the endometrial thickness,the number of oocytes retrieved and the cancellation cycle rate between the two groups(P>0.05).The progesterone levels in GH cycle [(3.31±1.46)nmol/L]were significantly lower than those in control group [(2.51±1.14)nmol/L](P<0.05).There was no significant difference in the fertilization rate and the rate of no available embryo for transplantation betweenthe two groups(P>0.05).The 2PN rate(67.48% vs.53.50%),and the available embryo rate(72.04%vs.38.26%),the optimal embryo rate(30.11%vs.15.44%)and the clinical pregnancy rate(43.48%vs.0%)significantly higher than those in the control cycles(P<0.05).Conclusions:The patients with pregnancy failure due to poor quality of embryos in the previous IVF cycle were received the pretreatment with human growth hormone prior to ovulation induction can improve embryo quality and clinical pregnancy rate,but its specific mechanism and application effect still need further study.