早卵泡期长方案血清LH低的患者添加r-LH的临床结局分析

Clinical outcome of r-LH supplementation in patients with lower serum LH level in the long down-regulation protocol of early follicular phase

目的探讨早卵泡期长方案促排卵过程中对于血清LH值低的患者给予重组人黄体生成素(r-LH)处理对妊娠结局的影响。方法回顾性分析2013年1月至2015年12月在我院行早卵泡期长方案促排卵患者的临床资料(共1 331个周期),按照促排卵后第8天(D8)是否补充r-LH将患者分为观察组和对照组。观察组(689个周期):D8开始每天补充r-LH至HCG注射日;对照组(642个周期):不添加r-LH,仅FSH促排卵至HCG注射日。比较两组患者的抱婴率、胚胎种植率、临床妊娠率等妊娠结局。结果两组患者降调节后血FSH、LH、E_2水平,HCG日LH水平、HCG日内膜厚度,Gn天数、Gn总量比较均无统计学差异(P>0.05)。观察组患者HCG日P水平、E_2水平均显著低于对照组(P<0.01)。观察组的获卵数、每周期平均冷冻胚胎数及全胚冷冻率均显著低于对照组(P<0.01)。观察组的MⅡ卵率、种植率、临床妊娠率、每周期抱婴率均略高于对照组,但是无显著性差异(P>0.05)。结论对于早卵泡期长方案促排卵过程中LH水平过度抑制(LH≤0.5U/L)的患者,添加r-LH有提高临床妊娠率的趋势,但仍需更大样本量的前瞻性研究加以验证。

Objective:To explore the effect of recombinant LH(r-LH)supplementation in patients with lower serum LH level in the long down-regulation protocol of early follicular phase on the pregnancy outcome.Methods:The data of patients undergone IVF/ICSI-ET treatment(1 331 cycles)in Jiangxi Province Maternal and Child Health Hospital from January 2013 to December 2015 were retrospectively analyzed.The patients were divided into the observation group(n=642)and control group(n=689)according to whether r-LH was supplemented on the 8 th day after ovulation induction.The patients in the observation group were daily supplemented r-LH from Day 8 to HCG injection days.The patients in the control group did not add r-LH,only stimulated with FSH to HCG injection day.The live birth rate,embryo implantation rate,clinical pregnancy rate were compared between the two groups.Results:The levels of FSH,LH,E 2,LH levels and endometrial thickness on HCG day,gonadotropin(Gn)days and total Gn dosage had no statistical difference between the two groups(P>0.05).The levels of progesterone and E 2 on HCG day in observation group were significantly lower than those in control group(P<0.01).The number of oocytes retrieved,the average number of frozen embryos per cycle and the rate of whole embryo freezing in the observation group were significantly lower than those in the control group(P<0.01).The MⅡoocyte rate,implantation rate,clinical pregnancy rate,the live birth rate in each cycle in the observation group were slightly higher than the control group,but no significant difference(P>0.05).Conclusions:For patients with over-repression LH levels(LH≤0.5 U/L)during ovulation induction with a long protocol in early follicular phase,supplementation of r-LH tends to increase clinical pregnancy rates but still requires a larger sample size prospective study to validate.