长效长方案超促排卵中晚期添加黄体生成素对体外受精-胚胎移植结局的影响

目的 探讨长效长方案控制性超促排卵过程中添加黄体生成素(LH)对体外受精-胚胎移植(IVF-ET)结局的影响.方法 回顾性分析在本院生殖中心接受IVF-ET治疗的120例不孕患者的临床资料,研究对象均于月经第3～5 d行人绝经期促性腺激素(HMG)促超排卵,当卵泡最大直径达14 mm时,按当日黄体生成素(LH)水平分为三组,每组40个周期,1组:LH＜1 mIU/ml;2组:1 mIU/ml≤LH＜2mIU/ml;3组:LH≥2 mIU/ml.每组再分为A组(20周期):继续使用HMG至HCG注射日;B组(20周期)每天添加重组黄体生成素(r-LH).比较各组的临床结局.结果 A1组促性腺激素(Gn)用量、Gn时间、流产率显著高于B1组,妊娠率显著低于B1组,差异有统计学意义(P＜0.05);两组间添加LH日及HCG日血清LH水平、获卵数、受精率比较差异均无统计学意义(P＞0.05).A2组妊娠率显著低于B2组,Gn用量、Gn时间、获卵数、受精率、流产率、添加LH日及HCG日血清LH水平比较差异均无统计学意义(P＞0.05).A3、B3组间各项指标比较差异均无统计学意义(P＞0.05).结论 长效长方案卵泡中晚期在LH＜2 mIU/ml时添加LH可提高妊娠率,尤其血清LH＜1 mIU/ml时添加LH可获较好的临床结局,LH＞2 mIU/ml时不能从添加LH中获益.

Effect of luteinizing hormone supplementation in middle or late follicle phase on the outcome of in vitro fertilization-embryo transfer of long protocol controlled ovarian hyperstimulation

Objective To explore the effect of luteinizing hormone (LH) supplementation on the outcome of in vitro fertilization-embryo transfer (IVF-ET) of long protocol controlled ovarian hyperstimulation (COH).Methods The clinical data of 120 IVF-ET cycles in center of clinical reproductive medicine of our hospital was analyzed retrospectively.All cases underwent long protocol down regulation with gonadotropin releasing hormone agonis (GnRH-a) in the mid-luteal phase,and controlled ovarian stimulation (COS) was carried out with HMG on the 3rd-5th day of the menstrual cycle.When a dominant follicle reached a diameter of 14 mm,all cases were divided into 3 groups according to the LH level:group one (40 cycles),LH ＜ 1 mlU/ml;group two (40 cycles),1 mlU/ml ≤ LH ＜ 2 mIU/ml;group three (40 cycles),LH ≥ 2 mlU/ml.According to the project of LH supplementation,each group were sub-divided into 2 subgroups:group A (20 cycles),without supplementation of r-LH;group B (20 cycles),with supplementation of r-LH.Clinical outcome of all groups were analyzed and compared.Results The duration and dose of gonadotropin (Gn) and abortion rate in group A 1 were higher than those in group B1,the rate of pregnancy was lower (P＜0.05).There were no statistically significant differences in serum LH concentration,the number of retrieved oocytes,the rate of fertilization on the day of r-LH and HCG administration between group A1 and group B1 (P＞0.05).The rate of pregnancy in group A2 was significantly lower than that in group B2 (P＜0.05).There were no statistically significant differences in the duration and dose of Gn,the number of retrieved oocytes,the rate of fertilization,abortion rate,serum LH concentration on the day ofr-LH and HCG administration between group A2 and group B2 (P＞0.05).There were no statistically significant differences in each indicator between group A3 and group B3 (P＞0.05).Conclusions When serum LH level was lower than 2 mIU/ml,especially lower than 1 mIU/ml,LH supplementation in middle or late follicle phase during IVF with long protocol could obtain higher pregnancy rate and lower abortion rate.The patients whose serum LH＞2 mlU/ml can not benefit from LH supplementation.