体外受精-胚胎移植促排卵早期添加重组人黄体生成素在低黄体生成素患者中的应用效果

Effect of early recombinant human luteinizing hormone supplementation during ovulation induction applied to in vitro fertilization-embryo transfer on patients with low luteinizing hormone

目的探讨在体外受精-胚胎移植(IVF-ET)促排卵早期添加重组人黄体生成素(r-h LH)在低黄体生成素(LH)患者中的应用效果。方法选取行IVF-ET的低LH患者306例,分为A组85例、B组166例和C组55例,给予黄体期长方案超排卵。A组、B组分别在启动促性腺激素(Gn)第1天、第5天开始添加r-h LH,C组全程单用Gn不添加r-h LH。比较3组患者的Gn用量及用药天数、人绒毛膜促性腺激素(h CG)注射日血清雌二醇(E2)及LH水平、内膜厚度、获卵数、胚胎移植数、正常受精率、优质胚胎率、着床率及临床妊娠率。结果 A组、B组、C组Gn用量依次增高(均P<0.05),且C组Gn用药天数均长于A组和B组(均P<0.05);3组间h CG日E2及LH水平、子宫内膜厚度、获卵数、平均移植胚胎数比较,差异均无统计学意义(均P>0.05);A组、B组、C组正常受精率、优质胚胎率依次降低(均P<0.05),且C组着床率与临床妊娠率均低于A组和B组(均P<0.05)。结论对于行IVF-ET长方案垂体降调节后LH过度抑制的患者,在促排卵期添加r-h LH,有利于改善妊娠结局,且早期添加效果更优。

Objective To explore the effect of early recombinant human luteinizing hormone（r-hLH） supplementation during the ovulation induction applied to in vitro fertilization and embryo transfer（IVF-ET） on the patients with low luteinizing hormon（LH）. Methods A total of 306 patients with low LH undergoing IVF-ET,who were treated with a long ovulation induction protocol in luteal phase,were divided into group A（85 cases）,group B（166 cases） and group C（55 cases）.Group A and group B received r-hLH supplementation on the 1st and 5th day respectively after gonadotropin（Gn） protocol launching,while group C was given Gn alone without r-hLH.The amount of and duration of Gn used,serum estradiol（E 2） and LH levels on the day of human chorionic gonadotropin（hCG） injection,endometrial thickness, number of retrieved oocytes,number of embryo transfer,normal fertilization rate,high-quality embryo rate,implantation rate and clinical pregnancy rate were compared among the three groups. Results The amounts of Gn of group A,group B and group C increased in turn（all P 〈0.05）, and the duration of Gn used in group C was longer than that in group A or B（all P 〈0.05）;there were no statistically significant differences among the three groups in the E 2 or LH level,endometrial thickness,number of retrieved oocytes,or mean number of embryo transfer（all P 〉0.05）;the normal fertilization rates and high-quality embryo rates of group A,group B and group C decreased in turn（all P 〈0.05）,and the implantation rate and clinical pregnancy rate in group C were lower than those in group A or B（all P 〈0.05）. Conclusion r-hLH supplementation during the ovulation induction,especially used in early stage,might contribute to improving the pregnancy outcome of patients with oversuppressed LH after IVF-ET with a long proposal of pituitary down-regulation.