回顾性、匹配病例对照研究：在 GnRH 拮抗剂方案中控制性卵巢超刺激时，重组 LH 与 hMG 对 FSH 的补充作用。
A retrospective, matched case-control study of recombinant LH versus hMG supplementation on FSH during controlled ovarian hyperstimulation in the GnRH-antagonist protocol.
机构信息
Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
出版信息
Front Endocrinol (Lausanne). 2022 Aug 15;13:931756. doi: 10.3389/fendo.2022.931756. eCollection 2022.
BACKGROUND
The role of luteinizing hormone (LH) in controlled ovarian hyperstimulation (COH) requires more evidence for its efficacy. Several studies compared recombinant human LH (r-hLH) or human menopausal gonadotropin (hMG) in combination with recombinant human follicle-stimulating hormone (r-hFSH) but lack the results with GnRH-antagonist protocol and in Asians.
METHODS
This is a retrospective, single-center study inspecting women receiving GnRH antagonist protocol and r-hFSH+hMG or r-hFSH+r-hLH regimen for over five days for COH in the fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycle in Taiwan from 2013 to 2018. The outcomes of IVF/ICSI cycles were analyzed after propensity score matching between the two groups. A subgroup analysis was conducted in cycles in which women underwent their first embryo transfer (ET), including fresh ET and frozen ET (FET).
RESULTS
With a total of 503 cycles, the results revealed that the r-hFSH+r-hLH group performed better in terms of numbers of oocytes retrieved (r-hFSH+hMG vs. r-hFSH+r-hLH, 11.7 vs. 13.7, p=0.014), mature oocytes (8.7 vs. 10.9, p=0.001), and fertilized oocytes (8.3 vs. 9.8, p=0.022), while other outcomes were comparable. The analysis of first ET cycles also showed similar trends. Although the implantation rate (39% vs. 43%, p=0.37), pregnancy rate (52% vs. 53%, p=0.90), and live birth rate (39% vs. 45%, p=0.19) were not significantly different, the miscarriage rate was higher in the r-hFSH+hMG group than the r-hFSH+r-hLH group (26% vs. 15%, p<0.05) in first ET cycles. The cumulative pregnancy rate was significantly higher in the r-hFSH+r-hLH group (53% vs. 64%, p=0.02). No significant difference in rates of ovarian hyperstimulation syndrome (OHSS) was observed.
CONCLUSION
The results support the hypothesis that the treatment of r-hLH+r-hFSH improves COH clinical outcomes in the IVF/ICSI cycle.
背景
黄体生成素（LH）在控制性卵巢过度刺激（COH）中的作用需要更多证据来证明其疗效。一些研究比较了重组人 LH（r-hLH）或人绝经促性腺激素（hMG）与重组人卵泡刺激素（r-hFSH）联合使用，但缺乏 GnRH 拮抗剂方案和亚洲人的结果。
方法
这是一项回顾性、单中心研究，对 2013 年至 2018 年间在台湾接受 GnRH 拮抗剂方案和 r-hFSH+hMG 或 r-hFSH+r-hLH 方案治疗超过 5 天的接受体外受精（IVF）/胞浆内精子注射（ICSI）的妇女的 COH 进行了分析。对两组患者进行倾向性评分匹配后，分析了 IVF/ICSI 周期的结果。在进行首次胚胎移植（ET）的周期中（包括新鲜 ET 和冷冻 ET[FET]）进行了亚组分析。
结果
共 503 个周期，结果显示 r-hFSH+r-hLH 组在取卵数（r-hFSH+hMG 与 r-hFSH+r-hLH，11.7 与 13.7，p=0.014）、成熟卵数（8.7 与 10.9，p=0.001）和受精卵数（8.3 与 9.8，p=0.022）方面表现更好，而其他结果则相似。首次 ET 周期的分析也显示出类似的趋势。虽然着床率（39%与 43%，p=0.37）、妊娠率（52%与 53%，p=0.90）和活产率（39%与 45%，p=0.19）无显著差异，但 r-hFSH+hMG 组的流产率高于 r-hFSH+r-hLH 组（26%与 15%，p<0.05）。首次 ET 周期的累积妊娠率 r-hFSH+r-hLH 组明显更高（53%与 64%，p=0.02）。卵巢过度刺激综合征（OHSS）的发生率无显著差异。
结论
结果支持 r-hLH+r-hFSH 治疗可改善 IVF/ICSI 周期中 COH 临床结局的假设。
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