标准人群接受人绝经期促性腺激素联合卵泡期长方案干预的妊娠结局观察

Observation on Pregnancy Outcome of Standard Population Receiving Intervention of Human Menopausal Gonadotropin Combined with Long Acting GnRH Agonist Long Protocol in Follicular Phase

目的观察标准人群接受人绝经期促性腺激素(hMG)联合卵泡期长方案干预的妊娠结局。方法选取2018年6月至2020年6月成都市第三人民医院收治的接受体外受精-胚胎移植且自身卵巢储备功能正常的非高龄孕妇276例作为研究对象。所有纳入对象均采取常规卵泡期长方案促排卵干预。使用SPSS软件随机生成数字进行编号,奇数者纳入试验组(n=111),偶数者纳入对照组(n=165)。对照组孕妇在方案实施期间不添加hMG,而试验组孕妇则全程添加hMG。疗程结束后,对两组孕妇进行至少12个月随访,记录并对比促排卵效果及妊娠结局。结果两组孕妇年龄、体重指数、基础卵泡刺激素(FSH)、黄体生成素(LH)水平、FSH/LH和窦卵泡数差异无统计学意义(P>0.05)。两组孕妇在注射绒膜促性腺激素(hCG)日雌二醇、孕酮、子宫内膜厚度、移植日子宫内膜厚度、获卵数、受精率、移植胚胎数、胚胎种植率差异无统计学意义(P>0.05)。试验组孕妇的临床妊娠率及活产率均高于对照组孕妇,差异有统计学意义(P<0.05)。结论对接受体外受精-胚胎移植且促排卵启动当日外周血LH水平<1 U/L的非高龄孕妇进行常规卵泡期长方案促排卵过程中,采用hMG干预能够有效调节孕妇FSH、LH激素水平及动态平衡,从而提升妊娠率以及胚胎质量,改善母婴妊娠结局。

Objective To investigate the pregnancy outcome of standard population receiving intervention of human menopausal gonadotropin(hMG) combined with long acting GnRH agonist long protocol in follicular phase. Methods A total of 276 non elderly pregnant women with normal ovarian reserve function receiving in vitro fertilization and embryo transfer(IVF-ET) in the Third People’s Hospital of Chengdu from June 2018 to June 2020 were selected. All the subjects included received conventional intervention of long acting GnRH agonist long protocol in follicular phase for ovulation induction. And they were randomly numbered by SPSS at admission. Those with odd numbers were divided into experimental group(n=111) and those with even numbers into control group(n=165). During the implementation of the scheme, hMG was not added in the control group, while it was in the experimental group throughout the whole process. After treatment, the two groups were followed up for at least 12 months, and the effect of ovulation induction and pregnancy outcome were recorded for comparative analysis. Results There was no significant difference in age, body mass index(BMI), basal follicle stimulating hormone(FSH) and luteinizing hormone(LH) levels, FSH/LH ratio and the number of antral follicles between the two groups(P>0.05). There was no significant difference between the two groups in estradiol, progesterone and endometrial thickness on the day of human chorionic gonadotropin(hCG) injection, endometrial thickness on the day of embryo transfer, number of eggs retrieved, fertilization rate, number of transferred embryos and embryo implantation rate(P>0.05). The clinical pregnancy rate and live birth rate in the experimental group were significantly higher than those in the control group(P<0.05). Conclusion In the process of ovulation induction by routine long acting GnRH agonist long protocol in follicular phase for non elderly pregnant women receiving IVF-ET and whose peripheral blood LH level is less than 1 U/L on the day of ovulation induction initiation, hMG intervention can effectively regulate the FSH and LH levels and their dynamic balance of pregnant women, so as to improve the pregnancy rate, embryo quality and maternal and infant pregnancy outcome.