卵泡期长方案HCG日LH水平对体外受精结局的影响

Effects of LH Level in Patients Receiving Long Protocol of Follicular Period Regimen HCG Injection on in vitro Fertilization Outcomes

目的探讨卵泡期长方案人绒毛膜促性腺激素(HCG)注射日(HCG日)血清促黄体生成素(LH)水平与体外受精胚胎移植(IVF-ET)治疗结局的关系。方法回顾性分析同济医学院生殖医学中心2015~2018年期间行IVF-ET卵泡期长方案助孕中抗苗勒管激素(AMH)水平>2 ng/mL的739个周期的临床资料。根据HCG日LH水平将其分为~0.5、~1.2、~2.0、~5.0、>5 U/L等5组,分析HCG日血清LH水平与促性腺激素(Gn)用量、Gn天数、优胚率、2PN受精率、获卵数及妊娠率的关系。结果 HCG日血清LH水平与Gn天数、优胚率、2PN受精率无相关性;但与Gn用药剂量、获卵数、妊娠率存在一定相关性。HCG日血清LH水平为~0.5、~1.2、~2.0、~5.0、>5.0 U/L的各组平均Gn用药剂量分别为(2327±451)、(2192±368)、(2061±356)、(2080±348)、(1595±262)U,LH≤0.5 U/L组用药剂量明显高于其它组(P<0.05),>5.0 U/L组用药剂量明显低于其它组(P<0.05),LH水平在0.5~5.0 U/L之间各组用药剂量相近,差异无统计学意义(P>0.05);HCG日LH≤2 U/L的3组较LH>2 U/L的2组获卵数增加(P<0.05);HCG日血清LH水平为~0.5、~1.2、~2.0、~5.0、>5.0 U/L的各组妊娠率分别为65.30%、69.93%、73.11%、71.43%和45.78%,LH>5.0 U/L组明显低于其它组(均P<0.01),LH水平在0.5~5.0 U/L之间各组妊娠率相近(P>0.05)。结论卵泡期长方案中HCG日血清LH水平>5.0 U/L者妊娠率明显降低,但过低的LH水平(≤0.5 U/L)会增加Gn用量,增加患者治疗费用。将HCG日血清LH水平控制在0.5~5.0 U/L之间可获得较好的治疗结局。

Objective To investigate the relationship between serum luteinizing hormone(LH)levels and the outcome of in vitro fertilization embryo transfer(IVF-ET)in human with follicular gonadotropin(HCG)injection.Methods The clinical data of 739 cycles of IVF-ET follicle long-term program with anti-Mullerian hormone(AMH)levels>2 ng/mL from 2015 to 2018 in the Reproductive Medicine Center of Tongji Medical College were retrospectively analyzed.According to LH level,it was divided into 5 groups,-0.5,-1.2,-2.0,-5.0,>5 U/L groups.The relationship between HCG daily serum LH level and Gonadotropin(Gn)dosage,Gn days,excellent embryo rate,2 PN fertilization rate,number of eggs obtained,and pregnancy rate were analyzed.Results There was no correlation between serum LH level(on HCG injection day) and Gn injection day,excellent embryo rate,2 PN fertilization rate.However,there was a certain correlation between serum LH level and the dose of Gn,the number of eggs obtained,and the pregnancy rate.The average Gn doses of the HCG daily serum LH levels of-0.5,-1.2,-2.0,-5.0,and >5.0 U/L groups were(2327±451),(2192±368),(2061±356),(2080±348),and(1595±262)U/L,respectively.The dose was significantly higher in LH≤0.5 U/L group than in the other groups(P<0.05),the dose was significantly lower in >5.0 U/L group than in the other groups(P<0.05),and the LH level was between 0.5-5.0 U/L.The doses of the groups were similar,and the difference was not statistically significant(P>0.05).The number of eggs obtained was higher in LH≤2 U/L group than in LH>2 U/L group(P<0.05).For-0.5,-1.2,-2.0,-5.0,and >5.0 U/L groups,pregnancy rate was 65.30%,69.93%,73.11%,71.43% and 45.78%,respectively.The pregnancy rate was significantly lower in LH>5.0 U/L group than in the other groups(P<0.01).The pregnancy rate of other groups was similar(P>0.05).Conclusion The pregnancy rate of >5.0 U/L group is significantly lower in the follicular long-term regimen,but too low LH level(≤0.5 U/L) can increase the amount of Gn,increase the cost of treatment for patients.A better therapeutic outcome can be obtained by controlling the serum LH level between 0.5 and 5.0 U/L.