不同促排卵方案中内源性黄体生成素峰对妊娠率的影响

目的在不同促排卵方案采用监测内源性黄体生成素(LH)峰、比较内源性LH峰前后注射hCG的周期临床妊娠率的差异,探讨内源性LH峰对妊娠率的影响。方法收集2007年7月至2009年1月在我院就诊的各种因素不育患者202例、344周期为对象。其中选用氯米酚(CC)促排卵189个周期(CC组),人绝经期促性腺激素(HMG)155个周期(HMG组)。用尿LH试纸监测内源性LH峰。结果(1)总周期妊娠率为9.3%(32/344)。临床妊娠与患者的年龄、不育年限,基础卵泡刺激素(FSH)、LH值,基础雌二醇(E_2)、睾酮水平及hCG注射日内膜厚度无显著相关,而与hCG注射日成熟卵泡数呈正相关,与卵泡直径呈负相关。(2)LH峰阳性组与LH峰阴性组患者的妊娠率无显著差异(12.8%vs 7.1%,P0.05)。在189个CC周期中,LH阳性组的临床妊娠率为14%(7/50),而LH阴性组为5.0%(7/139),有显著差异(P0.05);在155个HMG周期中,二者的妊娠率无显著差异(12.0%vs 11.1%,P0.05)。(3)两组LH阳性率为32.8%(133/344),阳性组基础LH、E_2水平显著低于LH阴性组(P0.05),但hCG注射日内膜厚度却明显大于阴性组(P0.01)。结论CC促排卵中等待内源性LH峰出现后注射hCG有利于提高临床妊娠率,而HMG促排卵中内源性LH峰是否出现可能不影响妊娠率。

A study on the correlation between a spontaneous luteinizing hormone surge in stimulation cycles and pregnancy rates

Objective： To investigate the relationship between the spontaneous luteinizing hormone （LH） surge and clinical pregnancy rates.
Methods： Two hundred and two patients （344 cycles） with various infertility factors were recruited in our hospital from Jul. 2007 to Jan. 2009. 189 cycles were stimulated with clomiphene citrate （CC） and 155 cycles with human menopausal gonadotrophin （hMG）. Human chorionic gonadotrophin （hCG） was used to induce follicular rupture after or before a spontaneous urinary LH surge. Rapid urinary LH test was used to monitor the urinary LH surge. The women with LH surge on hCG day were defined as surgepositive, while those without LH surge as surge-negative.
Results： （1） The pregnancy rate showed no significant correlation with the patient＇s age, length of infertile period, basal FSH, basal LH, basal E2, testosterone levels or the endometrial thickness on hCG day. Pregnancy rate was positively correlated with the number of follicles on hCG day but negatively correlated with the follicular diameters. （2） The pregnancy rates in surge-positive and surge-negative group were 12. 8% （17/133） and 7. 1% （15/211）, respectively. No significant difference was found between two groups. In CC-stimulated cycles, the pregnancy rate in surge-positive group （14.0%） was significantly higher than that in surge-negative group （5.0%） （P〈0.05）, while cycles the pregnancy rates in surge-positive and negative patients were similar （12.0% in hMG-stimulated vs. 11. 1%） （P〉 0.05）. （3） In all cycles, 32.8% （133/344） were surge-positive whose basal LH and E2 levels were significantly lower （P〈0.05）, while the endometrium on hCG day was significantly thicker than those in surge-negative group （P〈0.01）.
Conclusions. A better pregnancy rate may be achieved if a spontaneous LH surge occurs before hCG administration in CC-stimulated cycles, while in hMG-stimulated cycles, the occurrence of a spontaneous LH surge may not improve the pregnancy rate.