黄体期长效长方案中促黄体生成素添加时机对助孕结局的影响

Effect of timing of luteinizing hormone supplementation on pregnancy outcome in luteal phase long acting protocol

目的探讨黄体期长效长方案中促黄体生成素(luteinizing hormone,LH)不同添加时机对接受体外受精/卵胞质内单精子注射⁃胚胎移植助孕结局的影响。方法回顾性分析2019年9月至2021年3月在珠海市妇幼保健院生殖医学中心采用黄体期长效长方案助孕患者的240个周期;根据促性腺激素(Gn)启动日血清LH水平分为两组,A组190个周期[Gn启动日血清LH≤1 U/L,Gn启动第1日添加高纯度人绝经期尿促性腺激素(HP⁃HMG)];B组50个周期[Gn启动日血清LH>1 U/L,Gn启动第6日添加HP⁃HMG]。并对不同年龄阶段患者(≤35岁和36~40岁)进行分析。记录所有患者的Gn使用时间、Gn总用量、hCG日LH、雌二醇(E2)、孕酮(P)水平、ET日子宫内膜厚度、获卵数、MⅡ卵数、受精率、2PN率、卵裂率、优胚率、着床率、临床妊娠率、早期流产率以及中重度卵巢过度刺激综合征(OHSS)发生率。结果≤35岁的患者A1组和B1组分别为143个和32个周期,36~40岁的患者A2组和B2组分别为47个和18个周期。A1组患者Gn总量(2685.4±813.2 IU vs.2351.5±754.1 IU)、着床率(56.6%vs.41.1%)、临床妊娠率(79.0%vs.59.4%)及活产率(66.4%vs.46.9%)明显高于B1组,hCG日孕酮水平(1.2±0.5 nmol/L vs.1.6±0.7 nmol/L)低于B1组,差异均有统计学意义(P<0.05);A2组患者临床妊娠率(63.8%vs.27.8%)和活产率(44.7%vs.16.7%)均高于B2组,差异有统计学意义(P<0.05)。结论黄体期长效长方案中患者早期添加HP⁃HMG较中期添加可降低hCG注射日孕酮水平,提高着床率、临床妊娠率和活产率。

Objective To investigate the effect of different timing of LH supplementation in long⁃term luteal phase regimen on pregnancy outcome after IVF/ICSI⁃ET assisted pregnancy.Methods 240 cycles of IVF/ICSI⁃ET assisted pregnancy using the long⁃acting regimen in luteal phase were retrospectively analyzed in Reproductive Medicine Center of Zhuhai Maternal and Children′s Health Hospital from September 2019 to March 2021.Divided into two groups based on serum LH levels on the day of gonadotropin(Gn)initiation.There were 190 cycles in group A(LH≤1 U/L,HP⁃HMG was added on the first day of Gn initiation)and 50 cycles in group B(LH>1 U/L,HP⁃HMG was added on the sixth day of Gn initiation).Patients of different ages(≤35 years old and 36 to 40 years)were analyzed.Recorded the Gn use time,total Gn dosage,LH,estradiol(E2),progesterone(P)levels on hCG day of all patients,endometrial thickness on ET day,number of oocytes obtained,number of MⅡoocytes,fertilization rate,2PN rate,cleavage rate,excellent embryo rate,implantation rate,clinical pregnancy rate,miscarriage rate and the incidence of moderate to severe ovarian hyperstimulation syndrome(OHSS).Results Patients≤35 years old had 143 and 32 cycles in A1 group and B1 group respectively,and patients between 36 and 40 years old had 47 and 18 cycles in A2 group and B2 group respectively.The total amount of Gn(2685.4±813.2IU vs.2351.5±754.1 IU),implantation rate(56.6%vs.41.1%),pregnancy rate(79.0%vs.59.4%)and live birth rate(66.4%vs.46.9%)in A1 group were significantly higher than those in B1 group.hCG progesterone level(1.2±0.5 nmol/L vs.1.6±0.7 nmol/L)was lower than that of group B1,the differences were statistically significant(P<0.05).The pregnancy rate(63.8%vs.27.8%)and live birth rate(44.7%vs.16.7%)in A2 group were higher than those in B2 group,the differences were statistically significant(P<0.05).Conclusion Early addition of HP⁃HMG can reduce the level of hCG injection progesterone,and improve the implantation rate,pregnancy rate and live birth rate in patients with luteal phase long⁃term long⁃term regimen.