卵巢功能储备正常者拮抗剂方案COH使用过程中添加高纯度人绝经促性腺激素对IVF-ET妊娠结局的影响

Influence of high-purity human menopausal gonadotropin added in process of antagonist program COH in IVF-ET pregnancy outcome in patients with normal ovarian function reserve

目的:探讨卵巢功能储备正常者应用拮抗剂方案体外受精控制性超促排卵(COH)不同阶段添加高纯度人绝经促性腺激素(HP-hMG)对体外受精-胚胎移植(IVF-ET)妊娠结局的影响,阐明其可能的作用机制。方法:选取接受体外受精(IVF)治疗的25~40岁卵巢储备功能正常患者142例,采用回顾性分析的方法根据HP-hMG添加时机分为早期添加组(第1天添加HP-hMG)和中晚期添加组(第6天添加HP-hMG),分析2组患者的妊娠结局。结果:与早期添加组比较,中晚期添加组患者人绒毛膜促性腺激素(HCG)注射日雌二醇(E2)水平升高(P=0.042),孕酮(P)水平升高(P=0.016),直径>16mm及直径>18mm的卵泡数增加(P=0.035,P=0.026);与早期添加组比较,中晚期添加组患者成熟卵率、优质胚胎率和累积妊娠率升高(P=0.006,P=0.001,P=0.040)。结论:卵巢功能储备正常者应用拮抗剂方案COH时,在中晚卵泡期添加HP-hMG可改善累积妊娠结局。

Objective:To investigate the influence of high-purity human menopausal gonadotrophin(HP-hMG)added in different periods of antagonist program COH in the pregnancy outcom of in vitro fertilization-embryo transplantation(IVF-ET)of the patients with normal ovarian function reserve,and to clarify the possible mechanism.Methods:A totol of 142 patients aged from 25 to 40 years old with normal ovarian function underwent IVF treatment were selected.According to the timing of HP-hMG addition,they were divided into early addition group(HP-hMG was added on the first day)and middel and latel addition group(HP-hMG was added on the 6th day).The pregnancy outcomes of the patients were analyzed.Results:Compared with early addition group,the estradiol(E2)level on the day of human chorimic gonadotropin(HCG)injection in middle and late addition group was significantly increased(P=0.042)and the progesterone(P)level on the day of HCG injection was significantly decreased(P=0.016),the number of follicles with diameter>16 mm(P=0.035)and the number of follicles with diameter>18 mm(P=0.026)were increased.Compared with early addition group,the rate of mature follicles in middle and late addition group was increased(P=0.006),the rate of high quality embroy was increased(P=0.001),and the cumulative pregnancy rate was increa sed(P=0.040).Conclusion:The addition of HP-hMG at middle and late follicular phase can improve the pregnancy outcome in the patients with normal ovarition function reserve under went antagonist program COH.