基础LH水平过高患者拮抗剂方案中全程使用拮抗剂的效果观察  

Effect of using GnRH antagonist throughout course of antagonist protocol for patients with high basic LH level

作　　者：林海燕[1] 李予[1] 焦雪丹[1] 谢言信[1] 陈晓莉[1] 王文军[1] 张清学[1] LIN Hai-yan;LI Yu;JIAO Xue-dan;XIE Yan-xin;CHEN Xiao-li;WANG Wen-jun;ZHANG Qing-xue(Reproductive Center,Department of Gynecology&Obstetrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120)

机构地区：[1]中山大学孙逸仙纪念医院生殖医学中心,广州510120

出　　处：《生殖医学杂志》2020年第11期1403-1409,共7页Journal of Reproductive Medicine

基　　金：国家重点研发计划(2016YFC1000205);广东省省级科技计划项目(2016A020216011);广州市产学研协同创新重大专项对外科技合作专题(2016201604030008)。

摘　　要：目的探讨基础LH水平过高患者促排卵过程中全程使用拮抗剂的应用效果,为特殊患者拮抗剂方案中拮抗剂的添加时机提供参考。方法回顾性分析2018年1~12月于中山大学孙逸仙纪念医院生殖中心行拮抗剂方案IVF/ICSI助孕的促性腺激素(Gn)启动日LH水平升高(≥10 U/L)的患者资料,根据促性腺激素释放激素拮抗剂(GnRH-ant)添加时机分为2组:灵活方案添加GnRH-ant的患者42例为A组;Gn与GnRH-ant同时使用的患者22例为B组;另选取2018年8月启动日LH<10 U/L、灵活方案添加GnRH-ant的112例对照患者为C组。比较3组患者的基本临床资料、促排卵过程及治疗结局各指标。结果基本资料比较中,3组患者中A组女方年龄中位数显著小于其他两组(P<0.001),B组基础LH及抗苗勒管激素(AMH)均显著高于其他两组(P<0.001),A、B两组PCOS患者比例显著高于C组(P<0.001)。促排卵情况的比较:C组的Gn启动量、Gn总量显著高于其他两组(P<0.05),C组促排卵第5、6天及HCG注射日血LH水平显著低于其他两组(P<0.05),促排卵第5~6天,A、B组中LH≥10 U/L患者比例均略高于C组,但无显著性差异(P>0.05),A、B组的获卵数显著高于C组(P<0.05)。临床结局的比较:A、B、C组患者的每移植周期临床妊娠率相当,分别为45.83%、50.00%、45.45%(P>0.05),B组乐观累积活产率显著高于其他两组(P<0.05),而保守累积活产率3组间比较无显著性差异(P>0.05)。结论对于基础LH升高(≥10 U/L)的患者,拮抗剂方案中全程使用拮抗剂是可行的,可能有助于降低早发LH峰的发生风险及改善治疗结局。Objective:To explore the effect of using GnRH antagonist(GnRH-ant)throughout the course of GnRH-ant protocol for patients with high basic LH level to provide a reference for the timing of antagonist addition in the GnRH-ant protocol for special patients.Methods:The data of the patients who had high LH level on the initiation day(≥10 U/L)and underwent GnRH-ant protocol in Reproductive Center,Department of Gynecology&Obstetrics,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,from Jan.to Dec.2018 were retrospectively analyzed.According to the timing of addition of GnRH-ant,they were divided into 2 groups:42 patients with GnRH-ant added in the flexible protocol in group A;22 patients with gonadotropin(Gn)and GnRH-ant used at the same day in group B.In addition,112 patients with LH<10 U/L on the initiation day in Aug.2018 and GnRH-ant added to the flexible protocol were selected as group C.The baseline characteristics,induced ovulation status and clinical outcome measurements were compared among the three groups.Results:The median of age in group A was significantly younger than other two groups(P<0.001).The baseline LH and AMH in group B were significantly higher than those in other two groups(P<0.001).The percentage of PCOS in group A and B were significantly higher than group C(P<0.001).The initiation dose and total dosage of Gn in group C were significantly higher than that in other two groups(P<0.05).The blood LH level on the 5th and 6th day of ovulation induction and the day of HCG injection in group C was significantly lower than that of the other two groups(P<0.05).On the 5th to 6th day of ovulation induction,the proportion of patients with LH≥10 U/L in group A and B was slightly higher than that in group C,but there was no significant difference(P>0.05).The number of retrieved oocytes in group A and B was significantly higher than that in group C(P<0.05).The clinical pregnancy rates per transfer cycle of patients in groups A,B and C were 45.83%,50.00%and 45.45%respectively(P>0.05).The optimistic cumu

关 键 词：GnRH拮抗剂方案 黄体生成素 灵活方案 临床妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]