早卵泡期长方案促排卵过程中添加LH制剂对IVF/ICSI临床结局的影响

Effect of human luteinizing hormone on clinical outcome during in-vitro fertilization or intracytoplasmic sperm injection-embryo transfer

目的探讨体外授精-胚胎移植(IVF/ICSI-ET)过程中,早卵泡期长方案促排卵过程中添加人黄体生成素(LH)制剂处理对临床结局的影响。方法回顾性分析2017年1月~2018年8月在长沙市妇幼保健院行早卵泡期长方案促排卵患者的临床资料,共188个周期。按照促排卵过程中是否添加LH制剂将患者分为四组:A组[促性腺激素(HMG)组,72个周期]:促排卵过程中除使用卵泡刺激素(FSH),还添加HMG;B组(r-LH组,34个周期):促排卵中后期添加r-LH,C组(HMG+r-LH组,51个周期):促排卵过程中添加HMG,并在后期添加r-LH,D组(不添加LH组,31个周期):不添加任何LH制剂,仅使用FSH促排卵至HCG注射日。比较各组患者的获卵数、正常受精率、优质胚胎率、临床妊娠率、胚胎着床率等妊娠结局。结果各组患者年龄、不孕年限、降调节后血LH水平、获卵数、正常受精率、优胚率比较差异均无统计学意义(P>0.05)。各组患者促性腺激素(Gn)总使用量比较,差异有高度统计学意义(P<0.01),其中,A、B、C三组Gn总使用量均高于D组,C组高于A组,差异有统计学意义(P<0.05);各组患者Gn使用天数比较,差异有高度统计学意义(P<0.01),其中,B、C组Gn使用天数长于A组及D组,差异有统计学意义(P<0.05)。各组患者获卵数、正常受精率、优质胚胎率及着床率比较差异均无统计学意义(P>0.05)。各组临床妊娠率比较,差异有统计学意义(P<0.05),其中,B组高于A组和D组,差异有统计学意义(P<0.05)。结论对于早卵泡期长方案促排卵的患者中,适时添加LH制剂,特别是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 investigate the effect of human luteinizing hormone(LH)on clinical outcome during in-vitro fertilization or intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET).Methods Clinical data of patients with ovulation induced through long follicle stage regimen at the Reproductive Center of Changsha Maternal and Child Health Hospital from January 2017 to August 2018 were analyzed retrospectively,188 cycles.The patients were divided into four groups based on whether the LH preparation was added during the ovulation promotion or not:Group A[human menopausal gonadotropin(HMG)group,72 cycles]:HMG was included in addition to follicle-stimulating hormone(FSH),during ovulation.Group B(r-LH group,34 cycles):r-LH was added in addition to FSH in the later stage.Group C(HMG+r-LH group,51 cycles):HMG was added during ovulation promotion and r-LH group was added in the later stage(no LH group,P<0.05).Group D(31 cycles):no LH preparation was added.Only FSH was used to promote ovulation until the HCG injection day.Thereafter,the number of eggs,normal fertilization rate,high quality embryo rate,clinical pregnancy rate and embryo implantation rate were compared.Results No significant differences were observed in age,infertility years,blood LH level,number of oocytes acquired,normal fertilization rate and embryo rate among all groups(P>0.05).There was highly statistically significant difference in total dose of gonadotropin(Gn)among all groups(P<0.01),and the total doses of Gn of group A,B,and C were higher than that of group D,the differences were statistically significant(P<0.05).There was highly statistically significant difference in usage days of Gn among all groups(P<0.01),and the usage days of Gn of group B and C were longer than those of group A and D,the differences were statistically significant(P<0.05).There was no statistically significant difference in the number of oocytes,normal fertilization rate,high quality embryo rate and implantation rate in each group(P>0.05).There was statistically significant difference in clinical pregnancy rate among four groups(P>0.05),the clinical pregnancy rate of group B were higher than that of those group A and D,the differences were statistically significant(P<0.05).Conclusion For the patients with ovulation induced by long regimen in early follicular phase,the addition of LH,especially r-LH,exhibited a tendency to increase the clinical pregnancy rate.However,it still needs to be verified through a study based on larger sample size.