TSH水平对拮抗剂方案IVF/ICSI患者妊娠结局的影响  

Effect of TSH level on pregnancy outcome of IVF/ICSI patients with antagonist regimen

作　　者：刘林丽[1] 林舟[1] 叶健文[1] 林培红[1] 赖雪丹 吴铃 LIU Linli;LIN Zhou;YE Jianwen;LIN Peihong;LAI Xuedan;WU Ling(Department of Obstetrics and Gynecology,the First Hospital of Fuzhou City, Fuzhou 350004,China)

机构地区：[1]福州市第一医院妇产科

出　　处：《中国现代医生》2019年第23期34-38,共5页China Modern Doctor

基　　金：福建省福州市科技计划项目(2018-S-105-4);福建省自然引导性基金项目(2019D004)

摘　　要：目的探讨TSH对采用拮抗剂方案IVF/ICSI不孕症患者妊娠结局的影响。方法回顾性分析2017年7月~2018年3期间在浙江大学附属妇产科医院进修时收集的行IVF/ICSI周期的FT4、FT3水平和甲状腺自身抗体均正常的不孕症患者436例临床资料,根据TSH水平分为TSH<2.5 mIU/L、2.5 mIU/L≤TSH<4 mIU/L和TSH≥4 mIU/L三组,分析其临床结局。结果在HCG注射日,TSH≥4 mIU/L组LH水平(4.92±1.23)IU/L、P水平[0.67(0.41~1.12)]明显高于TSH<2.5 mIU/L组和2.5 mIU/L≤TSH<4 mIU/L组,差异有统计学意义。在胚胎质量和临床妊娠方面,TSH≥4 mU/L组的成熟卵母细胞数(7.24±5.80)、正常受精率(66.91%)、优胚率(59.10%)、临床妊娠率(46.32%)、活产率(36.76%)以及出生体重(3028.23±848.72)g均低于其余两组,且早期流产率上升(6.61%),差异有统计学意义。根据ROC曲线图计算出当TSH=3.65 mIU/L时对IVF妊娠结局有诊断意义。结论 TSH水平≥3.65 mIU/L开始对IVF/ICSI成功率、早期流产率以及新生儿体重产生影响,建议在不孕患者IVF前将TSH控制在3.65 mIU/L以下。Objective To investigate the effect of TSH on the pregnancy outcome of patients with IVF/ICSI infertility treated with antagonist regimen. Methods The clinical data of 436 infertility patients with normal FT4,FT3 and thyroid autoantibodies collected during the IVF/ICSI cycle collected by the author during the training period from July 2017 to 2018 in Zhejiang University were retrospectively analyzed. According to the TSH level, the patients were divided into TSH<2.5 mIU/L, 2.5 mIU/L≤TSH<4 mIU/L and TSH≥4 mIU/L three groups. The clinical outcome was analyzed. Results On the day of HCG injection, the LH level (4.92±1.23) and P level [0.67 (0.41-1.12) of the TSH≥4 mIU/L group was significantly higher than that of TSH<2.5 mIU/L group and 2.5 mIU/L≤TSH<4 mIU/L group, and the difference was statistically significant. In terms of embryo quality and clinical pregnancy, the number of mature oocytes (7.24±5.80), normal fertilization rate (66.91%), and excellent embryo rate (59.10%), clinical pregnancy rate (46.32%), live birth rate (36.76%) and birth weight (3028.23±848.72)g in the TSH≥4 mIU/L group were lower than those of the other two groups, and early abortion rate increased (6.61%). The difference was statistically significant. The ROC curve calculated that when TSH=3.65 mIU/L, it had diagnostic significance for IVF pregnancy outcome. Conclusion TSH level ≥3.65mIU/L begins to affect IVF/ICSI success rate,early abortion rate and neonatal weight. It is recommended to control TSH below 3.65mIU/L before IVF in infertile patients.

关 键 词：甲状腺激素 不孕症 拮抗剂方案 体外受精-胚胎移植 

分 类 号：R714.2[医药卫生—妇产科学]