不同促排卵方案排卵结局和不同受精方式妊娠结局的相关因素探讨

目的:探讨不同促排卵方案的排卵结局和不同受精方式妊娠结局的相关因素。方法:100例需诱发排卵或行宫腔内人工受精(IUI)治疗的不孕症患者,随机分为两组,分别采用hp-hMG或hMG促排。用化学发光法测量基础及治疗各期血清中的性激素水平。结果:两组患者应用促性腺激素的时间和剂量、卵泡数、排卵率、妊娠率无统计学意义。但hCG注射日大卵泡数(1.8±1.3vs2.5±1.9)、E2水平在hp-hMG组显著低于hMG组(577.77vs925.23pmol/ml),而P/E2水平无明显差别。合并两组后LH<4IU/L组的排卵率(100%)、妊娠率(27.5%)明显较LH>4IU/L组(90%和10.0%)增高,当hCG日子宫内膜厚度在8-12mm时妊娠率最高(21.3%);IUI患者hCG注射日E2水平、卵泡数(>14mm)和卵泡破裂数在妊娠组显著高于非妊娠组(E2:1324.00±971.52vs733.97±724.87pmol/L;卵泡数:3.28±2.39vs2.19±1.55;卵泡破裂数:2.2±1.1vs1.2±0.5),而P/E2在妊娠组显著低于非妊娠组(1.25±1.20vs2.62±2.05)。结论:hMG和hp-hMG在促排卵治疗中无论是排卵率、妊娠率均无明显差异,但hp-hMG更为有效;基础LH水平在促排卵治疗中对排卵率和妊娠率有重要作用;hCG注射日的E2和P/E2水平与妊娠率明显相关。

Discussion of the Relative Factors about the Outcome of Ovulation and Pregnancy by Different Inducing Protocol and Fertilizing Style

Objective: To evaluate the clinical profile and efficiency of s.c hp-hMG (Menopur(c), Ferring Labs) vs i.m. u-hMG (hMG Lizhu Pharmacy, China) in Chinese women undergoing controlled ovarian hyperstimu- lation and IUI. Methods: A controlled trial was done prospectively. A total of 100 Chinese women who need ovulation induction or IUI and were recruited between August 2004 and January 2005 were divided into two groups randomly: Group 1 (50 women) received 75 IU s.c.hp-hMG for 5 days, and then adjusted individually according to the ovarian response; group 2 (50 women ) received i.m u-hMG in a similar fashion. Results: Both groups were comparable in terms of age, BMI, E2 level (28.71 vs 35.52 pmol/ml) on the day 2, total dose of hMG administered. A significantly lower peak E2 level (577.77 vs 925.23 pmol/ml) and fewer total number of matured follicles (1.8± 1.3 vs 2.5 ±1.9), were observed in patients receiving hp-hMG when compared with u-hMG. No significant differences were observed in the number of ruptured follicles, ovulation rate, the level of P/E2 in the midluteal phase and pregnant rate. When we combined these two groups, we found that higher ovulation rate and pregnance rate in the LH<4 IU/L group than in the LH>4 IU/L group (27.5% vs 10.0%, 100% vs 90%). Higher pregnancy rate was attributed to higher level of E2, low level of P/E2 in the serium and the thickening of endometrium happened on the day of hCG injection. In the IUI group, the higher pregnant rate was associated with more follicles, more ruptured follicles, higher E2 level in the blood and lower P/E2 level. Conclusion: Both treatments showed a comparable clinical outcome and safety profile. There was a trend towards a better with hp-hMG, however, differences did not reach statistical significance probably due to sample size. But it seems that hp-hMG more efficiency, basal LH level plays an important role in the ovulation rate and pregance rate during stimulating ovulation; E2 and P/E2 level on the day of hCG injection are related with the outcome of pregnancy.