黄体生成素在控制性超排卵中的作用

The Role of Luteinizing Hormone on Controlled Ovarian Hyperstimulation

[目的]探讨体外受精与胚胎移植(IVF-ET)程序中注射人绒毛膜促性腺激素(HCG)日血清黄体生成素(LH)对控制性超排卵及其IVF-ET治疗结局的影响.[方法]收集分析我院2000年2月至2001年3月因女性输卵管因素不孕行IVF-ET治疗的481个周期的资料.按注射HCG日血清LH水平由低到高分3组,A组:LH＜1 IU/L,B组:LH≥1～＜5 IU/L和C组:LH≥5 IU/L.[结果]A组与其它两组比较,其注射卵泡刺激素(FSH)剂量增加(P＜0.001)、用药天数延长(P＜0.001)、而获卵数较多(P＜0.05),但受精率较低(P＜0.05),差异有统计学意义,A、B、C组的注射HCG日的E2水平、卵裂率、平均移植胚胎数、种植率、临床妊娠率及流产率的差异无统计学意义(P＞0.05).[结论]在控制性超排卵治疗中应维持适量的血清LH水平,如LH水平过低,应适当减少促性腺激素释放激素激动剂(GnRH-a)用量或加用LH.

[Objective] To evaluate the impact of serum luteinizing hormone(LH) levels during the day of human chorionic gonadotropin(HCG) administration on controlled ovarian hyperstimulation (COH) and its outcome of In Vitro Fertilization and Embryo Transfer (IVF-ET). [Methods] Data of 481 cycles with tubal factor infertility of IVF-ET performed in the Reproductive Medical Center of The First Affiliated Hospital, Sun Yat-sen University from February 2000 to March 2001, were analyzed retrospectively. Patients were divided into three groups according to serum LH levels on the day of HCG administra-tion(Group A: LH < 1 IU/L, Group B: LH≥1 ~ < 5 IU/L and Group C: LH≥5 IU/L). [Results] The amount of follicle stimulating hormone ( FSH) used and the number of oocytes retrieved were significantly more and the duration of stimulation was significantly longer in Group A than in the other two groups. However fertilization rates were lower. There were no significant differences in serum E2 levels on the day of HCG administration, cleavage rates, implantation rates, pregnancy rates and spontaneous abortion rates among different groups. [Conclusion] Low serum LH levels may adversely affect the outcome of controlled ovarian hyperstimulation of IVF-ET. Redution in the dosage of GnRH-a or addition of LH may be of clinical benefit when LH level is too low.