患有促性腺激素低下型性腺功能减退症的女性在试管婴儿中的生殖结局。
The Reproductive Outcome of Women with Hypogonadotropic Hypogonadism in IVF.
机构信息
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
出版信息
Front Endocrinol (Lausanne). 2022 Jun 6;13:850126. doi: 10.3389/fendo.2022.850126. eCollection 2022.
OBJECTIVE
The purpose of this study was to evaluate the reproductive outcome of patients with hypogonadotropic hypogonadism (HH) receiving fertilization and embryo transfer (IVF-ET).
METHODS
The reproductive outcome of 81 HH patients and 112 controls who underwent oocyte retrieval was evaluated retrospectively in the Center for Reproductive Medicine of Peking University Third Hospital from 2010 to 2019.
RESULTS
The basic levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), androstenedione (A) and prolactin (PRL) were significantly lower in the HH group than the control group. Although the HH patients required a significantly longer stimulation and higher gonadotropin (Gn) doses than the control patients, the total number of oocytes retrieved, fertilized embryos, two pronuclear (2PN) embryos, transferable embryos, fertilization and 2PN rates were comparable between the two groups. Although the live birth rate (LBR) of the first fresh cycle was higher in the control group than the HH group, there was no statistical significance. Then we further divided HH patients into two subgroups according to the etiology. Forty-one cases were termed as congenital HH (CHH), while the other 40 cases were termed as acquired HH (AHH), the latter includes functional hypothalamic amenorrhea (FHA) and pituitary HH (PHH). Our results showed that there were no significant differences in basic clinical characteristics and IVF parameters between the two groups. In the HH group, a total of 119 oocyte retrieval cycles were carried out and they responded adequately to ovulation induction. Urinary human menopausal gonadotropin (HMG) was used alone in 90 cycles while combination of HMG and recombinant human follicle stimulating hormone (rFSH) in the other 29 cycles. There were no significant differences in IVF-related parameters between the two groups. The conservative cumulative live birth rates (CLBRs) after the first, the second and ≥third cycles were 43.21%, 58.02% and 60.49%, respectively, while the corresponding optimal CLBRs were 43.21%, 68.45% and 74.19%. The preterm birth (PTB) rates of singletons and twin pregnancy in HH patients were 8.33% (3/36) and 30.77% (4/13), respectively.
CONCLUSION
IVF-ET is an effective treatment for HH patients with infertility and patients can get satisfactory pregnancy outcomes.
目的
本研究旨在评估接受体外受精和胚胎移植（IVF-ET）的低促性腺激素性性腺功能减退症（HH）患者的生殖结局。
方法
回顾性分析 2010 年至 2019 年北京大学第三医院生殖医学中心 81 例 HH 患者和 112 例对照组患者的卵母细胞采集的生殖结局。
结果
HH 组患者的卵泡刺激素（FSH）、黄体生成素（LH）、雌二醇（E2）、雄烯二酮（A）和催乳素（PRL）基础水平明显低于对照组。尽管 HH 患者的刺激时间明显长于对照组，所需的促性腺激素（Gn）剂量也高于对照组，但两组患者的取卵总数、受精胚胎数、二原核（2PN）胚胎数、可移植胚胎数、受精率和 2PN 率相当。尽管对照组新鲜周期的活产率（LBR）高于 HH 组，但无统计学意义。然后我们根据病因将 HH 患者进一步分为两组。41 例为先天性 HH（CHH），另 40 例为获得性 HH（AHH），后者包括功能性下丘脑性闭经（FHA）和垂体 HH（PHH）。我们的结果表明，两组患者的基础临床特征和 IVF 参数无显著差异。在 HH 组中，共进行了 119 个卵母细胞采集周期，这些周期对排卵诱导反应良好。90 个周期单独使用尿促性腺激素（HMG），29 个周期 HMG 与重组人卵泡刺激素（rFSH）联合使用。两组患者的 IVF 相关参数无显著差异。第一次、第二次和≥第三次周期的保守累积活产率（CLBR）分别为 43.21%、58.02%和 60.49%，相应的最佳 CLBR 分别为 43.21%、68.45%和 74.19%。HH 患者单胎和双胎妊娠的早产（PTB）率分别为 8.33%（3/36）和 30.77%（4/13）。
结论
IVF-ET 是治疗不孕 HH 患者的有效方法，患者可以获得满意的妊娠结局。
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