IVF-ET控制性卵巢刺激周期hCG注射日血清LH水平对治疗周期及妊娠结局影响

Effects of the serum luteinizing hormone level of women on the day of human chorionic gonadotropin injection during the controlled ovarian stimulation cycle of in vitro fertilization-embryo transfer on their treatment cycle and pregnancy outcomes

目的:探究人绒毛膜促性腺激素(HCG)注射日不同血清黄体生成素(LH)水平控制性卵巢刺激(COS)周期对体外受精-胚胎移植术(IVF-ET)患者促性腺激素(Gn)用量次数、获卵数、疗效及妊娠结局影响。方法:回顾性收集2020年6月-2021年12月于本院生殖中心行IVF-ET长效长期方案助孕的患者166例临床资料,根据hCG注射日LH水平分为低水平组(LH0.05);妊娠率高水平组(57.5%)高于低水平组(34.7%)和中水平组(37.9%),早期流产率(5.0%)低于低水平组(18.4%)和中水平组(11.5%)(P<0.05),低水平组和中水平组上述指标均无差异(P>0.05)。hCG注射日血清LH水平与Gn用量和Gn天数均呈负相关(均P<0.05);预测不良妊娠结局的曲线下面积为0.767,截断值1.35IU/L,特异性78.5%和敏感度72.7%。结论:hCG注射日不同血清LH水平与Gn用量和Gn天数呈负相关,且对不良妊娠结局评估价值较高,对于IVF-ET患者行长方案超排卵过程中,若HCG注射日血清LH水平较低,在一定程度上将增加Gn的应用剂量和用药天数,降低妊娠率并增加早期流产率,对患者结局造成不良影响。

Objective:To investigate the effects of different serum levels of luteinizing hormone(LH)of women on the day of human chorionic gonadotropin(HCG)injection during the controlled ovarian stimulation(COS)cycle of in vitro fertilization-embryo transfer(IVF-ET)on their gonadotropin Hormone(Gn)dosage frequency,the number of oocytes retrieved,efficacy,and pregnancy outcomes.Methods:A retrospective study was conducted on 166 women who underwent IVF-ET long-action and long-term assisted reproduction from June 2020 to December 2021.The women were divided into group A(49 women with LH<1IU/L),group B(87 women with 1 IU/L≤LH<2 IU/L),and group C(40 women with LH≥2IU/L)according to the LH level on the day of HCG injection.The dosage and days of Gn used,the number of oocytes retrieved,the endometrial thickness and estradiol(E2)level on the day of HCG injection,the rates of fertilization,cleavage,and quality embryo,and the pregnancy outcomes,such as symptomatic pregnancy rate and early miscarriage rate of the women in the three groups were observed.The correlation between the serum LH level of the women on the day of hCG injection and their dosage and days of Gn used was analyzed.The value of serum LH level of the women on the day of hCG injection for predicting their adverse pregnancy outcomes was also analyzed.Results:The dosage of Gn(2206.4±831.3IU)and the days of Gn used(11.1±1.4d)of the women in group C were significantly lower than those(2395.6±899.6IU and 12.0±1.7d)of the women in group A and those(2356.5±867.2IU and 11.8±1.5d)of the women in group B.The level of E2of the women in group C on the day of hCG injection was significantly higher than that of the women in group A and group B.The endometrial thickness of the women in group C on the day of hCG injection was significantly lower than that of the women in group A and group B(all P<0.05).There were no significant differences in the number of eggs obtained,the fertilization rate,the cleavage rate,and the optimal embryo rate of the women among the three groups(all P>0.05).The pregnancy rate(57.5%)of the women in group C was significantly higher than that(34.7%)of the women in group A and that(37.9%)of the women in group B,the early abortion rate(5.0%)of the women in group C was significantly lower than that(18.4%)of the women in group A and that(11.5%)of the women in group B(P<0.05),and which of the women had no significant differences between group A and group B(P>0.05).The serum LH level of the women on the day of hCG injection was negatively correlated with the dosage and the days of Gn used(all P<0.05).The area under the curve,the cut-off value,the specificity,and the sensitivity of the serum LH level of the women for predicting their adverse pregnancy outcomes were 0.767,1.35IU/L,78.5%,and 72.7%,respectively.Conclusion:The different serum LH levels of the women on the day of HCG injection were negatively correlated with their Gn dosage and the days of Gn used,and the serum LH level of the women has high value for evaluating their adverse pregnancy outcomes.During the superovulation process of the long-term regimen of the women with IVF-ET,the low level of serum LH on the day of HCG injection has a certain extent to increase the dosage and days of Gn used,reduce the pregnancy rate,and increase the early miscarriage rate,which will cause adverse influence on the outcomes of these women.