[补充黄体生成素对接受GnRH激动剂长方案的体外受精和胚胎移植患者结局的影响]
[Effects of luteinizing hormone supplementation on outcomes of in vitro fertilization and embryo transfer in patients undergoing GnRH-agonist long protocol].
作者信息
Deng Yu, Yin Min-Na, Liang Pei-Ling, Chen Zhi-Heng, Sun Ling
机构信息
1Assisted Reproductive Medical Center, Guangzhou Women and Children's Hospital, Guangzhou 510623, China; 2Enter of Reproductive Medicine, Department of Obstetrics and Gynecology, Nanfang Hospital, Guangzhou 510515, China. E-mail:
出版信息
Nan Fang Yi Ke Da Xue Xue Bao. 2017 Nov 20;37(11):1501-1505. doi: 10.3969/j.issn.1673-4254.2017.11.12.
OBJECTIVE
To compare the clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET) among patients in different conditions receiving luteinizing hormone supplementation in GnRH-agonist long protocol.
METHODS
Between June, 2010 and December, 2015, 671 IVF-ET cycles with GnRH-agonist long protocol were performed at our center. These cycles were divided into group A with FSH only and group B with FSH and recombinant luteinizing hormone (r-LH) supplementation, and each group was divided into 4 subgroups according to age (<35 or ≥35) and the LH level on the initial day (<1.0 U/L or ≥1.0 U/L). The effects of LH supplementation on the clinical pregnancy rate and implantation rate were compared among different subgroups.
RESULTS
No statistical significances were found between groups A and B in age, body mass index (BMI), basal FSH, basal LH, basal E2, Gn dosage, Gn day, LH on HCG day, E2 on HCG day, P on HCG day, number of oocytes, fertilization rate, available embryo rate or good quality embryo rate per oocyte, but the endometrium thickness on HCG day differed significantly between the two groups. In women below 35 years of age with a LH level on HCG day over 1.0 U/L, r-LH supplementation resulted in a clinical pregnancy rate of 60%, significantly lower than the rate of 79.55% in women without r-LH supplementation (P<0.05). In women over 35 years with a LH level below 1.0 U/L, r-LH supplementation resulted in an implantation rate of 44.74%, as compared with 24.74% in women without r-LH supplementation (P<0.05).
CONCLUSION
In the long protocol, LH supplementation does not improve the oocyte number, fertilization rate, or good quality embryo per oocyte, and does not bring benefits to women below 35 years with a low LH level (<1.0 U/L) or those over 35 years with normal LH level (≥1.0 U/L) after GnRH-agonist administration. But for women over 35 years with low LH levels, r-LH supplementation may improve the clinical pregnancy rate and implantation rate of IVF-ET cycles.
目的
比较在 GnRH 激动剂长方案中，不同情况的患者接受黄体生成素补充剂后进行体外受精-胚胎移植（IVF-ET）的临床结局。
方法
2010 年 6 月至 2015 年 12 月期间，在本中心进行了 671 个采用 GnRH 激动剂长方案的 IVF-ET 周期。这些周期被分为仅使用促卵泡激素（FSH）的 A 组和使用 FSH 并补充重组黄体生成素（r-LH）的 B 组，并且每组根据年龄（<35 岁或≥35 岁）和初始日的 LH 水平（<1.0 U/L 或≥1.0 U/L）分为 4 个亚组。比较不同亚组中补充 LH 对临床妊娠率和着床率的影响。
结果
A 组和 B 组在年龄、体重指数（BMI）、基础 FSH、基础 LH、基础雌二醇（E2）、促性腺激素（Gn）用量、Gn 使用天数、HCG 日的 LH、HCG 日的 E2、HCG 日的孕酮（P）、卵母细胞数量、受精率、可用胚胎率或每卵母细胞优质胚胎率方面均未发现统计学差异，但两组在 HCG 日的子宫内膜厚度存在显著差异。在 HCG 日 LH 水平超过 1.0 U/L 的 35 岁以下女性中，补充 r-LH 后的临床妊娠率为 60%，显著低于未补充 r-LH 的女性的 79.55%（P<0.05）。在 LH 水平低于 1.0 U/L 的 35 岁以上女性中，补充 r-LH 后的着床率为 44.74%，而未补充 r-LH 的女性为 24.74%（P<0.05）。
结论
在长方案中，补充 LH 并不能增加卵母细胞数量、受精率或每卵母细胞优质胚胎数量，并且对于 GnRH 激动剂给药后 LH 水平低（<1.0 U/L）的 35 岁以下女性或 LH 水平正常（≥1.0 U/L）的 35 岁以上女性没有益处。但对于 LH 水平低的 35 岁以上女性，补充 r-LH 可能会提高 IVF-ET 周期的临床妊娠率和着床率。
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