重组人生长激素在前次早卵泡期长效长方案体外受精失败患者中的应用

Application of recombinant human growth hormone in patients with previous in vitro fertilization failure

目的探讨在前次早卵泡期长效长方案体外受精(IVF)失败患者中添加重组人生长激素(rhGH),对患者胚胎质量及临床结局的影响.方法选择2017年4月至2018年4月期间在江西省妇幼保健院生殖中心行IVF-胚胎移植(ET)助孕治疗、无可利用胚胎或胚胎质量差而助孕失败的54例患者为研究对象.患者2个周期均采用早卵泡期长效长方案进行,第2周期添加rhGH预处理持续4周(GH组),促排卵期间rhGH维持至人绒毛膜促性腺激素(hCG)注射日,采用自身对照方法观察患者添加rhGH后胚胎质量及妊娠结局的改善.结果患者前后2次促排卵治疗促性腺激素(Gn)使用时间、Gn使用总量、hCG注射日子宫内膜厚度、雌激素水平、获卵数、双原核(2PN)卵裂率、移植胚胎数比较差异均无统计学意义(P>0.05).GH组中hCG注射日孕酮水平[(0.55±0.29)mg/L]、早期流产率(7.69%)、因胚胎质量差取消周期率(0%)显著低于自身对照组[(0.80±0.31)mg/L,P<0.001;66.67%,P=0.042;24.07%,P<0.001];GH组2PN受精率(64.36%)、可利用胚胎率(56.08%)、临床妊娠率(50.98%)、种植率(42.39%)显著高于自身对照组(53.90%,31.75%,7.50%,4.84%),差异均有统计学意义(P均<0.001).结论对于接受早卵泡期长效长方案促排卵治疗但因胚胎质量不佳导致助孕失败的患者,再次促排卵治疗中结合小剂量rhGH预处理,可以显著提高胚胎质量,从而改善妊娠结局.

Objective To investigate the effect of recombinant human growth hormone (rhGH) on embryo quality and clinical outcome of patients used an early follicular phase prolonged protocol with previous in vitro fertilization (IVF) failure. Methods From April 2017 to April 2018, 54 patients who had pregnancy failure due to no available embryo or poor quality of embryo in the previous cycle with early follicular phase prolonged protocol were selected for the study. Patients used an early follicular phase prolonged protocol both before and after in the two cycles. In the second cycle, rhGH pretreatment was added for 4 weeks (GH group), and rhGH was maintained until human chorionic gonadotropin (hCG) injection day during ovulation induction. The improvement of embryo quality and the pregnancy outcome after rhGH addition was observed by self-control method. Results There were no significant differences in the duration of gonadotropin (Gn) used, total dosage of Gn used, the endometrial thickness and estrogen levels on hCG injection day, the number of oocytes retrieved, two pronucleus (2PN) cleavage rate, embryo transfer number per cycle between the two groups (P>0.05). In GH group, the progesterone levels on hCG injection day [(0.55±0.29) mg/L], the early abortion rate (7.69%) and the cancellation cycle rate due to poor embryo quality (0%) were significantly lower than those in control group [(0.80±0.31) mg/L, P<0.001;66.67%, P=0.042;24.07%, P<0.001]. The 2PN fertilization rate (64.36%), the available embryo rate (56.08%), the clinical pregnancy rate (50.98%) and the implantation rate (42.39%) in GH group were significantly higher than those in control group (53.90%, 31.75%, 7.50%, 4.84%)(all P<0.001). Conclusion Low dose rhGH pretreatment can significantly improve embryo quality and pregnancy outcome in patients who had previous pregnancy failure due to poor embryo quality, and received an early follicular phase prolonged protocol in IVF cycles.