黄体期添加生长激素对辅助生殖助孕患者治疗结局的影响

Effect of adjuvant growth hormone during luteal phase on in-vitro fertilization-embryo transfer outcome

目的探讨在促排卵前一周期的黄体期添加生长激素(GH)对正常卵巢反应患者辅助生殖助孕结局的影响。方法收集2019年1月1日至2020年6月30日在湖南省妇幼保健院生殖中心行长效GnRH-a长方案的体外受精-胚胎移植(IVF-ET)助孕患者,其中106例患者在促排卵前一周期的黄体期添加GH(GH组),212例患者未添加GH(对照组)。比较两组的促排卵情况及妊娠结局。结果(1)GH组和对照组患者原发/继发不孕比例、不孕年限、年龄、移植与否比例比较差异均无统计学意义(均P>0.05)。(2)GH组和对照组患者获卵数、成熟卵(MII)卵子数、正常受精胚胎(2PN)数、优质胚胎数、移植胚胎数差异均无统计学意义(均P>0.05);GH组Gn总量少于照组[(1863.00±610.52)IU vs(2109.75±555.75)IU,P<0.05]。(3)对照组和GH组患者的胚胎着床率分别为43.73%(129/295)和60.42%(87/144),差异有统计学意义(P<0.05);对照组和GH组患者临床妊娠率分别为58.79%(107/182)和71.91%(64/89),差异有统计学意义(P<0.05);对照组患者早期妊娠自然流产率(4.67%,5/107)稍高于GH组(3.12%,2/64),但差异无统计学意义(P>0.05)。结论对于卵巢反应正常的患者,在促排卵前一周期的黄体期开始添加小剂量GH,可提高患者的胚胎着床率、临床妊娠率,减少Gn的用量,可使患者获益。

Objective To investigate the effect of growth hormone(GH)supplementation during luteal phase one cycle before ovulation induction in patients undergoing in vitro fertilization-embryo transfer(IVF-ET).Methods IVF-ET pregnancy-assisted patients who underwent long-term Gonadotropin Releasing Hormone-agonist(GnRH-a)protocol from January 1,2019 to June 30,2020 were collected from the Reproductive Center of Hunan Provincial Maternal and Child Health Hospital.Among them,106 patients(GH group)were added with GH during luteal phase one cycle before ovulation induction,and 212 patients(control group)were not added with GH.Ovulation induction and pregnancy outcome were compared between the two groups.Results(1)There was no statistically significant difference in primary infertility/secondary infertility rate,infertility years,age,and transplant cancellation cycle rate between the two groups(all P>0.05).(2)There were no significant differences in the number of oocytes obtained,MII oocytes,two pronucleus(2PN)oocytes,high-quality embryos and average number of transplanted embryos between GH group and control group(all P>0.05).The total amount of Gn in control group and GH group was(2109.75±555.75)IU and(1863±610.52)IU,respectively,with statistically significant difference(P<0.05).(3)The embryo implantation rate of the control group and GH group was 43.73%(129/295)and 60.42%(87/144),respectively,with statistically significant difference(P<0.05).The clinical pregnancy rates of the control group and GH group were 58.79%(107/182)and 71.91%(64/89),the difference was statistically significant(P<0.05).The spontaneous abortion rate of early pregnancy in control group(4.67%,5/107)was slightly higher than that in GH group(3.12%,2/64),but there was no significant statistical difference(P>0.05).Conclusions For patients with normal ovarian response,adding small dose of growth hormone during luteal stage one cycle before controlled hyperovulation can improve the embryo implantation rate and clinical pregnancy rate,and reduce the amount of Gn,which is beneficial to patients.