高龄妇女降调节方案中补充人基因重组黄体生成激素对卵巢反应性及着床率的影响  

Effects of the Supplemental Recombinant Human Luteinizing Hormone on the Ovarian Stimulation and Implantation Rate in Those Down-regulated Women of Advanced Reproductive Age

作　　者：叶虹[1] 黄国宁[1] 裴莉[1] 曾品鸿[1] 张孝东[1] 罗秀[1] 

机构地区：[1]重庆市妇产科医院遗传与生殖研究所,400013

出　　处：《国际生殖健康／计划生育杂志》2012年第5期388-392,共5页Journal of International Reproductive Health/Family Planning

基　　金：重庆市卫生局资助项目(2009-2-099)

摘　　要：目的:研究中国高龄妇女常用促性腺激素释放激素激动剂(GnRHa)长方案补充人基因重组黄体生成激素(rLH)的有效性。方法:选择2010年3月—2011年11月收治的接受体外受精/胞浆内单精子注射(IVF/ICSI)助孕的320个周期,进行同期前瞻随机开放对照临床试验。所有受试者均具有正常促性腺功能,年龄35～40岁,且均为首次接受IVF/ICSI助孕的不孕女性。采用黄体期曲普瑞林(Triptorelin)0.05 mg/d长方案。从人基因重组卵泡刺激素(rFSH)启动日开始按计算机分配的序号随机分为5组:①对照组(C组,n=61):仅用rFSH促排卵。②T1组(n=63):rFSH促排卵第6天(D6)开始补充rLH 75 IU/d至人绒毛膜促性腺激素(hCG)注射日。③T2组(n=65):D6开始补充rLH 150 IU/d至hCG注射日。④T3组(n=68):rFSH促排卵第1天(D1)开始补充rLH 75 IU/d至hCG注射日。⑤T4组(n=63):D1开始补充rLH 150 IU/d至hCG注射日。rFSH启动剂量均为225 IU/d,共5 d,然后根据卵巢反应调整剂量。结果:无论rLH补充的时间、剂量的不同以及是否补充rLH,控制性卵巢刺激(COS)后的获卵数、获成熟卵数、受精率、着床率及妊娠结局差异均无统计学意义(P>0.05)。结论:补充rLH对正常促性腺功能的高龄妇女无明显益处,因此,排卵功能正常的高龄妇女COS采用Triptorelin 0.05 mg/d降调节方案时,rLH补充并非必需。Objective：To evaluate the effects of recombinant human luteinizing hormone （rLH） supplementation on the ovarian stimulation and implantation rate in those down-regulated Chinese women of advanced reproduetive age. Methods：This is a prospective randomized controlled trial. 320 eyeles of ART were analyzed. All infertile patients with consecutive normogonadotrupie function, aged 35-40 years, underwent their first IVF or intracytoplasmic sperm injection （ICSI） treatment cycle. After pituitary suppression with Triptoreliu acetate 0.05 mg/d s.c started in the midluteal phase of the previous cycle, the patients were randomized divided into five groups：①control group（n=61 ）：only received rFSH tor ovarian stimulation until day of hCG injection. ②T1 （n=63）：rLH 75 IU/d supplementation on day 6 of rFSH stimulation until day of hCG injection. ③T2 （n= 65）：rLH 150 IU/d supplementation on day 6 of rFSH stimulation until day of hCG injection. ④T3 （n=68）：rLH 75 IU/d supplementation on day 1 of rFSH stimulation until day of hCG injection. ⑤T4 （n=63）：rLH 150 lU/d supplementation on day 1 of rFSH stimulation until day of hCG injection. Ovarian stimulation was initiated with rFSH 225 IU/d, 5 days in all of groups. Results：No significant differences were observed in terms of number and maturity of ooeytes,fertilized ooeytes,implantation rate and pregnancy rate among groups （P〉0.05）. Conclusions：The rLH supplementation with daily doses 75 or 150 IU during early follicular phase or second half follicular phase dose not improve ovarian response and implantation rates in those normogonadotropie women of advanced reproductive age who were stinmlated with rFSH under pituitary suppression with Iriptorelin acetate 0.05 mg/d s.e fi）r IVF,therefore the rLH supplementatinn is not needed in all down regulated women of advanced reproduetive age.

关 键 词：促黄体素 受精 体外 卵泡刺激素 人 控制性促排卵 不孕 女(雌)性 年龄因素 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]