基础卵泡刺激素/黄体生成素比值与控制性超排卵中卵巢反应性的关系

目的探索血基础卵泡刺激素(FSH)/黄体生成素(LH)比值及启动日FSH/LH比值在预测控制性超排卵(COH)中卵巢反应性的价值。方法对891个COH周期分为超排卵治疗不反应组（70个周期）、低反应组(56个周期)及正常反应组(765个周期)，比较了3组的基础FSH、LH和雌激素(E2)水平，以及使用促性腺激素释放激素激动剂(GnRHa)后FSH、LH和E2水平的变化，促性腺激素（Gn）的用量等。激素的测定采用全自动酶联免疫分析法。结果不反应组的基础FSH值为9.7IU/L±7.8IU/L，分别与低反应组（7.8IU/L±5.4IU/L）及正常反应组(6.4IU/L±2.0IU/L)比较均差异有显著意义（P<0.01）。不反应组的基础FSH/LH比值为2.9，分别与低反应组（2.0）及正常反应组(1.6)比较差异有显著意义（P<0.05）。使用GnRHa1周后(启动日月经来潮1～3d)，不反应组FSH/LH比值为5.3，低反应组为3.9，两者与基础水平比较均明显增高（P均<0.01），而正常反应组(2.6)增高不明显。基础E2水平在低反应组增高,与正常反应组比较P=0.09。结论当基础FSH<15IU/L时，可以通过使用GnRHa后，FSH/LH比值的显著增加及E2水平来进一步判断卵巢的反应性，指导临床用药。

The predication of ovarian response in control ovarian hyperstimulation by the ratio of basal FSH and LH level

OBJECTIVE: To study the basal FSH/LH ratio and its changes to prognosticate the ovary reserve. METHODS: 891 regularly cycling patients (IVF) participate. They were divided into three groups (the cancellation group which included using gonadotrophins one week later, there were 3 or less follicles to growth on ultrasound examination: 70cycles; the low response group defined as the collection of fewer or equal than 4 oocytes: 56 cycles; normally response group, the collection of more then 4 oocytes: 765 cycles). On the menstruation day 2 - 3 (basal level) and after using GnRHa, serum follicle stimulating hormone (FSH), luteinzing hormone (LH) and estradiol (E2) were demonstrated by immunoassay and analyzed by SPSS, the dose of gonadotrophins (Gn) and the treatment. RESULTS: The basal FSH levels of cancellation group (9.7 IU/L +/- 7.8 IU/L), the low response group (7.8 IU/L +/- 5.4 IU/L), and normally response group (6.4 IU/L +/- 2.0 IU/L) have significant difference in the three groups P < 0.001. The basal FSH/LH ratio of the cancellation group (2.9), the low response group (2.0), and normally response group (1.6) have significant difference P < 0.05. And after using GnRHa, the 1 - 3 day of menstruation and before starting of Gn, the FSH/LH ratio became more higher in the cancellation group and the low responder group, FSH/LH > 5 and 4 respectively, the normally response group FSH/LH < 3, also there were significantly difference between them P < 0.001. The basal E2 levels in the normal response group were significantly lower than that in the low responder group. CONCLUSION: The data suggest that although serum FSH level on D2-D3 doesn't reach 15IU/L, the basal FSH/LH > 2. After using GnRHa, the FSH/LH ratio became significantly higher, and the basal E2 level is higher, which is useful in prognostic assessment of ovarian bad reserve.