长方案卵巢刺激启动日血黄体生成激素水平作为黄体生成激素添加指标的价值  

Serum LH concentrations on the day 1 of ovarian stimulation was regarded as an index to identify LH supplementation in long protocol

作　　者：骆丽华 刘雨生 季静娟 郑圣霞 栾红兵 吴莉 

机构地区：[1]安徽医科大学附属省立医院妇产科生殖医学中心,安徽合肥230001

出　　处：《中国实用妇科与产科杂志》2012年第8期619-623,共5页Chinese Journal of Practical Gynecology and Obstetrics

摘　　要：目的探讨长方案卵巢刺激启动日血黄体生成激素(LH)水平作为LH添加指标的价值。方法回顾性分析安徽医科大学附属省立医院2009年9月至2010年8月因单纯性输卵管性不孕及梗阻性无精症接受促性腺激素释放激素激动剂(GnRH-a)长方案体外受精(IVF)和单精子胞浆内显微注射技术(ICSI)的313例(313个周期)不孕患者的治疗结果,根据卵巢刺激启动日血清LH水平将患者分为两组:血LH<1U/L组(151个周期)及血LH≥1U/L组(162个周期)。两组根据LH添加方案再分成不同亚组。血LH<1U/L组分为4个亚组:未添加组(20个周期)、早期添加组(20个周期)、晚期添加组(66个周期)及慢反应添加组(45个周期)。血LH≥1U/L组分为3个亚组:未添加组(36个周期)、晚期添加组(75个周期)及慢反应添加组(51个周期)。结果 (1)在血LH<1U/L组,早期添加组正常受精率高于未添加组(P<0.05);与其他3组相比,慢反应添加组启动日雌二醇(E2)水平降低,促性腺激素(Gn)总量及用药天数增加(P<0.05)。(2)在血LH≥1U/L组,慢反应添加组与其他两组相比,基础卵泡刺激素(FSH)水平、Gn总量及用药天数升高,人绒毛膜促性腺激素(HCG)日E2水平降低(P<0.05);晚期添加组HCG日孕酮(P)水平明显高于其他两组(P<0.05)。(3)血LH<1U/L组中未添加组正常受精率及种植率显著低于血LH≥1U/L组中未添加组,前者Gn用量、妊娠早期丢失率高于后者(P<0.05)。血LH<1U/L组中晚期添加组Gn用量高于血LH≥1U/L组中晚期添加组,前者HCG日E2水平低于后者(P<0.05)。结论长方案卵巢刺激启动日血LH水平可作为添加LH的一个有用指标。启动日血LH<1U/L患者早期添加LH对IVF、ICSI结局更有利;启动日血LH≥1U/L患者,仅在伴有FSH慢反应时可以从LH添加中获益。Objective To investigate the value that serum LH concentrations on the day 1 of ovarian stimulation was regarded as an index to identify LH supplementation in long protocol. Methods Retrospective analyzed the outcomes of IVF/ICSI in 313 infertile patients with tubal infertility and obstructive azoospermia during the period of September 2009 to August 2010. All of them accepted Gonadotropin releasing hormone agonist （GnRH-a） long protocol. According to serum LH concentration on the day 1 of ovarian stimulation, they were divided to 2 groups： serum LH 〈 1 U/L group （ 151 cycles） and serum LH ≥ 1 U/L group （ 162 cycles）. According to the project of LH supplementation they were subdivided to 4 subgroups in serum LH 〈 1 U/L group： not add subgroup（20 cycles）, early add subgroup （20 cycles） ,late add subgroup（66 cycles） and low response add subgroup（45 cycles）, they were subdivided to 3 subgroups in serum LH ≥ 1 U/Lgroup ： not add subgroups （ 36 cycles）, late add subgroup （ 75 cycles ） and low response add subgroup （ 51 cycles）. Results （ 1 ） In serum LH 〈 1 U/L group , normal fertilization rates in early add subgroup was higher than that in not add subgroups（P 〈0.05） ; in low response add subgroup,the levels of serum E2 on the day 1 of ovarian stimulation were lower, Gn ampoules and Days of stimulation were higher than that in other subgroups （ P 〈 0. 05 ）. （ 2 ） In serum LH 〉1 1 U/L group , in low response add subgroup , Basic FSH, Gnampoules and Days of stimulation were higher than thatin other subgroups, the levels of serum E2 on the day of HCG was lower than that in other subgroups, （ P 〈 0.05 ） ; in late add subgroup , the levels of serum P on the day of HCG was higher than that in other subgroups （ P 〈 0. 05 ）. （ 3 ） Normalfertilization rate and implantation rate in serum LH 〈 1 U/L and not add subgroup were lower than that in serum LH≥ 1 U/Land not add subgroup , Gn ampoules and early trimester of pregnancy loss ra

关 键 词：黄体生成激素 控制性超排卵 长方案 体外受精-胚胎移植 

分 类 号：R321[医药卫生—人体解剖和组织胚胎学]