促性腺激素释放激素激动剂降调节后血清黄体生成素水平对体外受精-胚胎移植结局的影响

目的探讨促性腺激素释放激素激动剂（GnRH-a）降调节后月经第3天血清黄体生成素（LH）水平对体外受精-胚胎移植（IVF—ET）结局的影响。方法回顾分析2006年6月至2010年6月在我院接受IVF-ET治疗288个周期的临床资料。患者均采用GnRH—a长方案进行垂体降调节，按降调后月经第3天血清黄体生成素（LH）水平分为三组，A组：LH≤1U／L，共57个周期；B组：1U／L〈LH≤2．5U／L，共188个周期；C组：2．5u／L〈LH〈5U／L，共43个周期。比较三组促性腺激素（Gn）使用天数、剂量，人绒毛膜促性腺激素（hCG）注射日血清雌二醇（E2）、LH水平及子宫内膜厚度、获卵数、受精率、卵裂率、优质胚胎率、临床妊娠率及流产率。结果hCG注射日血清E2和LH水平在三组间呈递增趋势，各组间血清LH水平有显著性差异（P〈0．05），而Gn天数、Gn用量、获卵数、卵裂率在各组间均无显著性差异（P〉0．05）；A组的优质胚胎率和临床妊娠率显著低于B、C组（P〈0．05），C组的流产率显著高于A、B组（P〈0．05）。结论GnRH—a降调节后月经第3天血清LH水平过低可导致hCG注射日E2和LH水平下降，影响子宫内膜厚度，并导致受精率、优质胚胎率及临床妊娠率下降，流产率上升，但LH过高也可导致流产率增加。

Effects of serum luteinizing hormone levels after pituitary down-regulation with GnRH agonist on the outcome of in vitro fertilization-embryo transfer

Objective： To evaluate the impact of serum levels of luteinizing hormone （LH） on day 3 of menstruation after pituitary down-regulation with gonadotropin releasing hormone agonist （GnRH-a） on the outcome of in vitro fertilization-embryo transfer （IVF-ET）. Methods： Two hundreds and eighty eight IVF cycles from June 2006 to June 2010 were retrospectively analyzed. All the cases accepted long down-regulation protocol with GnRH-a. According to serum LH levels on day 3, all patients were divided into group A （LH≤I U/L, 57 cycles）, group B （1 U/L〈 LH≤ 2.5 U/L, 188 cycles） and group C （2.5 U/L〈LH〈5 U/L, 43 cycles）. The total doses and duration of gonadotropin, LH and estradiol levels （E2） as well as endometrial thickness on the day of human chorionic gonadotropin （hCG） administration, the number of retrieved oocytes, fertilization rate, cleavage and high- quality embryo, clinical pregnancy and abortion rates were compared among three groups. Results. There were no significant differences in gonadotropin （Gn） dosage and duration, number of oocytes retrieved and cleavage rate among three groups, but the E2 and LH levels were increased progressively on the day of hCG administration from group A to group C, the LH levels showed significant difference among three groups （P〈0.05）. The number of high-quality embryos and clinical pregnancy rate in group A significantly decreased compared with group B and group C （P〈0.05）, meanwhile the abortion rate in group C significantly increased compared with groups B and A （P〈0.05）. Conclusion： Over-suppressed LH levels on day 3 of menstruation after pituitary down-regulation with GnRH-a would decrease the levels of LH and Ez on the day of hCG administration, and could have a negative effect on fertilization and embryo quality, resulting in deduction of clinical pregnancy rates and increment of abortion rate. However, if LH levels were too high on the day 3 of hCG administration, that would also significantly increase abortion rate.