注射绒毛膜促性腺激素日血清促黄体生成素水平对妊娠结局的影响

目的探讨长方案促排卵体外受精-胚胎移植(IVF-ET)患者应用促性腺激素释放激素激动剂(GnRHa)垂体降调节后，绒毛膜促性腺激素(HCG)注射日血清促黄体生成素(LH)水平对妊娠结局的影响。 方法回顾性分析2016年1月至2017年12月，在山东大学附属生殖医院女性生殖科，应用长方案促排卵行IVF-ET患者1 461例。根据HCG注射日血清LH水平及临床妊娠结局行ROC曲线分析，根据血清LH水平分为A组(血清LH≤1.58 IU/L)与B组(血清LH>1.58 IU/L)。比较两组HCG注射日血清LH水平对妊娠结局的影响。用Logistic回归法分析促性腺激素(Gn)用药天数、Gn用药总量对临床妊娠率的影响。 结果A组Gn用药天数[(11.28±2.46)d]较B组[(9.92±2.09)d]长，差异有统计学意义(t＝8.99，P<0.01)；A组Gn用药总量[(2 322.13±1 054.77)IU]较B组[(1 789.85±692.51)IU]大，差异有统计学意义(t＝8.60，P<0.01)。A组临床妊娠率(61.8%，201/325)较B组(69.7%，792/1 136)低，差异有统计学意义(χ²＝7.21，P<0.01)。A组早期流产率(11.9%，24/201)较B组(6.7%，53/792)高，差异有统计学意义(χ²＝5.37，P<0.05)。Gn用药天数、Gn用药总量与临床妊娠率进行Logistic回归分析，Gn用药天数(B＝－0.005，wald χ²＝0.052，OR＝0.995，P>0.05)、Gn用药总量(B＝0.000，wald χ²＝0.000，OR＝1.000，P>0.05)不是影响临床妊娠率的独立危险因素。 结论长方案促排卵中，HCG注射日血清LH≤1.58 IU/L患者Gn用量增加，Gn用药天数延长，且临床妊娠率下降、早期流产率增高；Gn用药天数、用药总量不影响临床妊娠率。

The effect of human chorionic gonadotrophin injection day serum luteinizing hormone level on pregnancy outcome

ObjectiveTo discuss the effect of human chorionic gonadotropin (HCG) injection day serum luteinizing hormone (LH) levels on pregnancy outcome in women undergoing in vitro fertilization-embrgo transfer (IVF-ET) with long protocols. MethodsA retrospective study including 1 461 cases was performed in reproductive center affiliated to Shandong University from January 2016 to December 2017. Serum LH levels were measured on the day of HCG administration. Two groups were divided according to the ROC curve between serum LH levels and pregnancy outcome, the LH≤1.58 IU/L in group A and LH>1.58 IU/L in group B. The Logistic regression was used to analyze the relationship between the total dose, duration of gonadotropin (Gn) and the clinical pregnancy rate. ResultsThe duration of Gn in group A was (11.28±2.46)d, which was longer than that in the group B[(9.92±2.09)d], and the difference was statistically significant (t=8.99, P<0.01). The total dose of Gn in group A was (2 322.13±1 054.77)IU, which was higher than that in the group B[(1 789.85±692.51)IU], and the difference was statistically significant (t=8.60, P<0.01). The clinical pregnancy rate of group A (61.8%, 201/325) was lower than that in group B(69.7%, 792/1 136), and the difference was statistically significant (χ²=7.21, P<0.01). The early abortion rate of group A (11.9%, 24/201) was lower than that in group B(6.7%, 53/792), and the difference was statistically significant (χ²=5.37, P<0.05). According to the Logistic regression, neither the duration of Gn (B=-0.005, wald χ²=0.052, OR=0.995, P>0.05), nor the total dose of Gn(B=0.000, wald χ²=0.000, OR=1.000, P>0.05) was the independent risk factors for clinical pregnancy rate. ConclusionsDuring long protocol, for the patients with the LH levels less than 1.58 IU/l on the day of HCG administration, the duration of Gn extended, the total dose increase, and it will lead to the lower pregnancy and higher early abortion rate. The total dose, and duration of Gn are uncorrelated with the clinical pregnancy rate.