拮抗剂方案促排卵过程中促黄体生成素水平对体外受精妊娠结局的影响

Effect of LH level on pregnancy outcome of IVF-ET during controlled ovarian hyperstimulation with antagonist protocol

目的探讨拮抗剂方案控制性促排卵(COH)周期中卵巢储备功能正常的不孕症患者黄体激素(LH)水平对体外受精-胚胎移植(IVF-ET)妊娠结局的预测价值。方法回顾性分析2015年1月至2016年6月间在南京市妇幼保健院采用拮抗剂方案COH且卵巢功能正常进行IVF-ET治疗的192位患者的临床资料,选择三个LH测定点:LH_8(促性腺激素使用8d后LH值)、LH_(扳机)(扳机日LH值)、LH_(扳机后)(扳机后24hLH值),根据Tukey’s hinges将每个测定点按LH数值由低到高分成三组:A组(LH水平位于区间前25%),B组(LH水平位于区间25%~75%),C组(LH水平位于区间后25%),比较各组间的获卵数、正常受精率、种植率、临床妊娠率、早期流产率。结果各组的年龄、体质量指数(BMI)、基础促卵泡生成素(FSH)水平、基础LH水平、扳机日孕酮(P)水平、促性腺激素(Gn)总量、Gn天数、拮抗剂使用天数差异均无统计学意义;在LH_8测定点,A组获卵数明显高于其余两组[(7.48±2.36)vs.(6.61±2.79)、(7.48±2.36)vs.(5.71±2.30)],差异有统计学意义(P<0.05);LH_(扳机)测定点三组扳机日的E_2水平分别为(16 436.94±6 981.81)pmol/L、(13 764.99±6 063.13)pmol/L及(11 768.08±5 207.58)pmol/L,获卵数分别为(7.67±2.31)、(6.61±2.69)及(5.40±2.44);LH_(扳机后)测定点三组扳机日的E_2水平分别为(15 645.36±6 240.03)pmol/L、(14 803.72±6 217.86)pmol/L及(10 343.75±5 097.41)pmol/L,获卵数分别为(7.58±2.70)、(6.85±2.44)及(5.10±2.34);在LH_(扳机)及LH_(扳机后)两个测定点,A组扳机日E_2水平及获卵数均明显高于其余两组,差异有统计学意义(P<0.05);各组间的正常受精率、种植率、临床妊娠率、早期流产率均无显著性差异。结论在拮抗剂方案COH过程中,晚卵泡期及扳机日低水平的LH可预测较高的获卵数,但LH水平高低并不影响最终的妊娠结局。

Objective: To explore the predicting value of LH level on pregnancy outcome of controlled ovarian hyperstimulation(COH)with antagonist protocol in infertile patients with normal ovarian reserve function.Methods: The data of 192 patients with normal ovarian reserve function who received COH with antagonist protocol in Nanjing Maternal and Child Health Care Hospital from January 2015 to June 2016 were retrospectively analyzed.Serum LH levels were determined on Day 8after application of gonadotropin(LHday8),HCG trigger day(LH_(trigger))and 24 hour after trigger(LH_(post trigger)).The patients were respectively divided into the following three groups on each determined time point:group A:LH<25^(th) percentile,group B:LH=25^(th) to 75 th percentile and group C:LH>75^(th) percentile according to Tukey's hinges.The number of oocytes retrieved,normal fertilization rate,implantation rate,clinical pregnancy rate and early miscarriage rate were compared among the three groups.Results: The patients' characteristics were comparable in all the three groups with regard to age,BMI,basal FSH level,basal LH level,progesterone level on triggering day,total dosage and duration of gonadotropin used,and duration of antagonist application.On LHday8 time point,the number of oocytes retrieved in group A was significantly higher than that in the group B & C[(7.48±2.36)vs.(6.61±2.79)vs.(5.71±2.30)](P<0.05).On LHtriggertime point,E_2levels[(16 436.94±6 981.81)vs.(13 764.99±6 063.13)vs.(11 768.08±5 207.58)pmol/L ]and the number of oocytes retrieved[(7.67±2.31)vs.(6.61±2.69)vs.(5.40±2.44)]in group A were significantly higher than those in the other two groups(P<0.05).On LHpost triggertime point,E_2levels[15 645.36±6 240.03)vs.(14 803.72±6 217.86)vs.(10 343.75±5 097.41)pmol/L ]and the number of oocytes retrieved[(7.58±2.70)vs.(6.85±2.44)vs.(5.10±2.34)]were also significantly higher than those in the other two groups(P<0.05).The fertilization rate of 2PN,implantation rate,clinical pregnancy rate and early miscarriage rate were also comparable among all the three groups.Conclusions:In GnRH antagonist protocol,low serum LH level on the day of late follicular phase or HCG trigger day can predict to retrieve more oocytes.However,the LH level does not affect the pregnancy outcome.