预防性控制血清促甲状腺素水平对IVF/ICSI-ET妊娠早期的影响  

The effect of preventative control of serum thyrotropin level at less than2.5 mU/L on early pregnancy of in vitrofertilization/intracytoplasmic sperm injection and embryo transfer

作　　者：贾博钦 宋学茹[1] 赵晓徽[1] 白晓红[1] 张慧娟[1] 王艳霞[1] 

机构地区：[1]天津医科大学总医院生殖医学中心,300052

出　　处：《中国计划生育学杂志》2014年第12期830-833,836,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨预防性控制血清促甲状腺素(TSH)水平<2.5mU/L对体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)妊娠早期的影响。方法:因单纯输卵管因素或男方因素不孕初次接受IVF/ICSI-ET治疗的不孕患者181例,在初诊及IVF/ICSI治疗前1个月时检测血清游离甲状腺素(FT4)、促甲状腺素(TSH)水平。满足两次检测2.5mU/L<TSH≤5.0mU/L者随机分为两组,未用左甲状腺素片(L-T4)预治疗的42例为A组,应用L-T4预治疗并维持TSH<2.5mU/L的34例为B组;满足两次检测TSH≤2.5mU/L的105例为C组,比较3组IVF/ICSI-ET结果。结果:3组对象年龄、促性腺激素(Gn)用量、获卵数、内膜厚度、受精率、优胚率、胚胎移植数、生化妊娠率均无统计学差异(P>0.05);A组胚胎种植率和临床妊娠率(27.9%、45.2%)较B组(49.2%、79.4%)、C组(42.9%、65.7%)低,早期流产率(31.6%)较B组(7.4%)、C组(11.6%)高,差异均有统计学意义(P<0.05),B组与C组比较差异均无统计学意义(P>0.05)。结论:对于2.5mU/L<TSH≤5.0mU/L的不孕患者使用L-T4预治疗,使TSH水平维持在<2.5mU/L,对其IVF/ICSI-ET早期妊娠结果有正面影响。Objective： To explore the effect of preventative control of serum thyrotropin levels at less than 2.5 mU/L on early pregnancy with in vitro fertilization /intracytoplasmic sperm injection and embryo transfer （IVF/ICSI--ET）. Methods： A study was performed on 181 infertility patients undergoing initial IVF/ICSI--ET because of simple fallopian tubes factor or male factor from March 31, 2013 to March 31, 2014. The concentrations of serum free thyroxine （FT4） and thyroid--stimulating hormone （TSH） were evaluated at first visit and a month before the beginning of IVF/ICS1--ET treatment. The patients with TSH levels between 2.5 mU/L and 5.0 mU/L were randomly divided into two groups. Women in group A （n=42） did not use L--thyroxine tablets （L--T4）, TSH level in those of group B （n =34） were lowered at less than 2.5 mU/L after the use of L--T4, and TSH level in those of group C was not more than 2.5 mU/L in at least two measures （n= 105）. The outcomes of IVF/ICSI--ET for each group were compared. Results： Age, gonadotropins dosage, number of oocyte, endometrial thickness, fertilization rate, embryo quality rates, number of embryo transferred and biochemical pregnancy rate had no statistically significant differences among three groups （P〈0.05） Embryo implantation rate and clinical pregnancy rate of group A （27.9 %, 45.2%） were low er than those of group B （49.2 %, 79.4%） and group C （42.9 %, 65.7 %） ; Trimester miscarriage rate of group A （31.6 %） was higher than those of group B （7.4%） and group C （11.6%）, showing statistically significant differences （P〈0.05）. Conclusion： Patients with TSH levels between 2.5mU/L and 5.0mU/L lowered at less than 2.5mU/L after the prophylactic use of L--T4 has a positive effect on early pregnancy of IVF / ICSI--ET.

关 键 词：促甲状腺素 左甲状腺素片 体外受精/卵细胞浆内单精子注射 妊娠早期 

分 类 号：R714.8[医药卫生—妇产科学]