早卵泡期长效长方案添加不同外源性黄体生成素制剂对低黄体生成素患者体外受精-胚胎移植临床结局的影响

Effects of different sources of luteinizing hormone preparations in the early follicular phase prolonged protocol on clinical outcome of in vitro fertilization and embryo transfer in patients with low luteinizing hormone

目的探讨早卵泡期长效长方案添加不同外源性黄体生成素制剂对低黄体生成素(LH)患者体外受精-胚胎移植临床结局的影响。方法选择2017年4月至2020年5月在新乡医学院第三附属医院生殖医学科行体外受精-胚胎移植(IVF-ET)助孕、垂体降调后LH<1.0 U·L^(-1)的238例女性患者为研究对象。所有患者采用早卵泡期长效长方案,给予基因重组促卵泡激素促排卵,在卵泡直径12~14 mm时添加外源性LH制剂,根据添加LH的不同将患者分为重组黄体生成素(r-LH)组(n=116)和人绝经期促性腺激素(HMG)组(n=122)。比较2组患者降调时间、促性腺激素(Gn)启动量、Gn使用时间、Gn总量、添加LH日血LH水平、人绒毛膜促性腺激素(HCG)注射日子宫内膜厚度、HCG注射日LH水平、HCG注射日孕酮(P)水平、HCG注射日雌二醇(E_(2))水平及获卵数、2PN卵数、MII卵数、卵裂数、受精数、优质胚胎数、受精率、2PN卵率、MII卵率、全胚冷冻周期率、优质胚胎率、种植率、临床妊娠率。结果2组患者降调时间、Gn启动量、Gn总量、HCG注射日E_(2)水平、HCG注射日子宫内膜厚度比较差异均无统计学意义(P>0.05),r-LH组患者Gn使用时间、添加LH日血LH水平、HCG注射日P水平显著低于HMG组(P<0.05),HCG注射日LH水平显著高于HMG组(P<0.05)。2组患者获卵数、2PN卵数、MII卵数、卵裂数、受精数、优质胚胎数、受精率、2PN卵率、MII卵率、全胚冷冻期率、种植率、临床妊娠率比较差异均无统计学意义(P>0.05);r-LH组患者优质胚胎率高于HMG组(P<0.05)。结论Gn启动日低LH水平患者在早卵泡期长效长方案促排卵过程中补充r-LH较补充HMG可显著增加体内LH水平,提高优质胚胎率,缩短患者Gn使用时间,临床应用安全性更高。

Objective To investigate the effect of different sources of luteinizing hormone preparations in the early follicular phase prolonged protocol on the clinical outcome of in vitro fertilization and embryo transfer in patients with low luteinizing hormone(LH)level.Methods A total of 238 female patients with in vitro fertilization embryo transfer(IVF-ET)assisted pregnancy and LH<1.0 U·L^(-1) after pituitary down regulation in the Department of Reproductive Medicine of the Third Affiliated Hospital of Xinxiang Medical University from April 2017 to May 2020 were selected as the research objects.All patients were treated with a long-acting long-term plan in early follicular stage,and they were given recombinant follicle stimulating hormone to promote ovulation.Exogenous LH preparation was added when the follicle diameter was 12-14 mm.Accor-ding to the different LH preparations,the patients were divided into the recombinant LH(r-LH)group(n=116)and human menopausal gonadotropin(HMG)group(n=122).The time of depression,the amount of starting gonadotropin(GN),the use time of GN,the total amount of GN,the blood LH level on the day of adding LH,the endometrial thickness on the day of human chorionic gonadotropin(HCG),the LH level on the day of HCG injection,the progesterone(P)level on the day of HCG injection,the estradiol(E_(2))level on the day of HCG injection,the number of retrieved eggs,the number of 2PN eggs,the number of MII eggs,the number of cleavages,the number of fertilizations,the number of high-quality embryos,the rate of fertilization,the rate of 2PN eggs,the rate of MII eggs,the rate of whole embryo freezing cycle,the rate of high-quality embryo,the rate of implantation and the rate of clinical pregnancy were compared between the two groups.Results There was no significant diffe-rence in the time of depression,the amount of starting GN,the total amount of GN,the E_(2) level on the day of HCG injection and endometrial thickness on the day of HCG injection between the two groups(P>0.05).The use time of GN,the blood LH level on the day of adding LH and the P level on the day of HCG injection in the r-LH group were significantly lower than those in the HMG group(P<0.05);and the LH level on the day of HCG injection was significantly higher than that in the HMG group(P<0.05).There was no significant difference in the number of 2PN eggs,the number of MII eggs,the number of cleavages,the number of fertilizations,the number of high-quality embryos,the rate of fertilization,the rate of 2PN eggs,the rate of MII eggs,the rate of whole embryo freezing cycle,the rate of implantation and the rate of clinical pregnancy between the two groups(P>0.05);the rate of high-quality embryos in the r-LH group was significantly higher than that in the HMG group(P<0.05).Conclusion In patients with low LH level on the day of GN initiation,r-LH supplementation can significantly increase the level of LH in vivo,improve the rate of high-quality embryos,shorten the use time of GN,and has higher clinical safety compared with HMG supplementation in the process of ovulation induction with the early follicular phase prolonged protocol.