超长降调节超促排卵日促黄体素水平对子宫内膜异位症体外受精结局的影响

目的探讨改良超长降调节方案超促排卵启动日促黄体素(LH)与子宫内膜异位症患者体外受精(IVF)结局的关系。方法 50例子宫内膜异位症患者接受改良超长方案治疗,患者接受性腺素释放激素激动剂(GnRH-a)治疗3～6 mo,每次曲普瑞林1.88 mg肌注,间隔28 d,第2次注射后2 wk开始检测血清CA125,CA125降至18 U.L-1以下后注射曲普瑞林1.88 mg,于末次注射后2～6 wk开始促性腺素超促排卵行体外受精-胚胎移植(IVF-ET)治疗。按超促排卵启动日血清LH水平分为2组:A组25例,LH<0.5 U.L-1;B组25例,LH≥0.5 U.L-1,比较2组IVF-ET结局。结果 A组促性腺素平均用药天数多于B组[(14.71±24.96)d vs.(8.86±1.92)d,P<0.01],A组种植率低于B组(24.56%vs.33.33%,P<0.05)。结论改良超长降调节方案治疗子宫内膜异位症患者启动日LH过低将增加促性腺素用药天数,降低种植率。建议将LH作为超排启动的主要指标。

Effect of luteinizing hormone level in day of superovulation start of prolonged down-regulation on outcomes of in vitro fertilization-embryo transfer in patients with edometriosis

ATM To evaluate the effect of serum LH level in the day of superovulation start of the prolonged down-regulation on the outcomes of in vitro fertilization-embryo transfer(IVF-ET)in patients with edometriosis.METHODS Fifty patients received three to six months of long-acting GnRH agonist(GnRH-a),triptorelin 1.88 mg im every 28 days.Serum CA125 level was detected every two weeks from the the second injection of GnRH-a.When Serum CA125 level was lower than 18 U·L-1,the last dose of GnRH-a was injected,and then gonadotropin(HMG + FSH)was started 2 to 6 weeks later.Conventional IVF-ET was performed as routine procedure.All patients were divided into two groups according to the level of serum LH.Group A included 25 patients whose level of LH was less than 0.5 U·L-1,and group B included 25 patients whose level of LH was over 0.5 U·L-1.The outcomes of IVF-ET in the two groups were compared.RESULTS The average days used with gonadotropin in group A were more than those in group B[(14.71 ± 24.96)d vs.(8.86 ± 1.92)d,P < 0.01].The implantation rate in group A was lower than that in group B(24.56% vs.33.33%,P < 0.05).CONCLUSION If the serum LH level in the day of superovulation start in the prolonged down-regulation was too low,it maybe increase the total gonadotropin used day and decrease the implantation rate.So serum LH level can be regarded as a main reference index to the start of ovarian hyperstimulation.