正常促性腺激素妇女垂体降调节后晚卵泡期黄体生成素浓度对体外受精结局的影响

目的 :探讨正常促性腺激素妇女超促排卵时晚卵泡期黄体生成素 (LH)水平对体外受精 (IVF)结局的影响。　方法 :正常促性腺激素妇女 4 32个周期 ,于黄体中期开始采用促性腺激素释放激素激动剂 (GnRHa)行垂体降调节后 ,应用卵泡刺激素 (FSH)刺激卵巢的促排卵方案。当卵泡直径达 1 4mm时 ,添加hMG(FSH +hMG组 ) ,对照组不添加hMG(FSH组 )。hCG注射日测定血LH和雌二醇 (E2 )浓度。按照LH浓度 ,将FSH +hMG组分为 4个亚组。　结果 :FSH +hMG组的hCG注射日E2 浓度高于FSH组 [(3435 .5 1± 2 0 2 9.0 1 )pg/ml和 2 6 2 0 .6 2± 1 6 0 4 .80 )pg/ml,P<0 .0 5 ],胚胎移植数少于后者 [(2 .77± 0 .4 5 )个和 (2 .2 2± 0 .4 6 )个 ,P <0 .0 0 1 ]。两组受精率、胚胎种植率和临床妊娠率无统计学差异 (77.5 2 %和 78.31 %,4 1 .4 2 %和 4 1 .6 8%,6 4 .5 6 %和 6 2 .6 4 %,P均 >0 .0 5 ) ;FSH +hMG组的 4个亚组的受精率、胚胎种植率和临床妊娠率也无统计学差异 (P >0 .0 5 )。　结论 :正常促性腺激素妇女超促排卵时 ,晚卵泡期血清LH在生理范围内以及在晚卵泡期适量添加LH ,不会对IVF结局产生负面影响。

Effect of Concentration of Circulating Luteinizing Hormone in Late-follicle Phase on the Outcome of in vitro Fertilization for Normogonadotrophic Women

OBJECTIVE: To evaluate the impact of the concentration of circulating luteinizing hormone (LH) in the late-follicle phase on the outcome of in vitro fertilization for normogonadotrophic women. METHODS: Intracytoplasmic sperm injection treatment was conducted in 432 consecutive cycles of normogonadotrophic women. A stimulation protocol with mid-luteal gonadotropin-releasing hormone (GnRH) agonist down-regulation and ovarian stimulation with follicle stimulating hormone (FSH) was used in all cycles. hMG was added when a follicle of > or = 14 mm was present (FSH + hMG group), not in the control group (FSH-alone). LH and oestradiol concentration in the serum on hCG day were detected. Based on LH levels, patients in the FSH + hMG group were again divided into four subgroups: LH < or = 1, 1 < LH < or = 2, 2 < LH < or = 3, and 3 < LH < or = 10 IU/L. RESULTS: Oestradiol concentration on the day of hCG injection in the FSH + hMG group was higher than that in the FSH-alone group [(3435.51 +/- 2029.01) pg/ml vs (2620.62 +/- 1604.80) pg/ml, P < 0.05]. More embryos were transferred in the FSH-alone group than in the FSH + hMG group [(2.77 +/- 0.45) vs (2.22 +/- 0.46), P <0.001]. Fertilization rate, implantation rate, and clinical pregnancy rate were similar between the FSH-alone group and the FSH + hMG group (77.52% vs 78.31%, 41.42% vs 41.68%, 64.56% vs 62.64%, P > 0.05), as well as among the four subgroups of the FSH + hMG group (P > 0.05). CONCLUSION: The adding of suitable amount of hMG and physiologically limited LH concentration in the late-follicle phase have no negative effect on the outcome of in vitro fertilization/intracytoplasmic sperm injection for normogonadotrophic women.