多囊卵巢综合征患者拮抗剂方案中早发LH升高对IVF-ET临床结局的影响  

Effect of premature LH elevation on IVF-ET outcome of GnRH antagonist cycle in patients with polycystic ovary syndrome

作　　者：肖珊 莫美兰 刘苏 洪玲 王雪金 游静 张宏展 XIAO Shan;MO Mei-lan;LIU Su;HONG Ling;WANG Xue-jin;YOU Jing;ZHANG Hong-zhan(Department of Reproductive Medicine,Shenzhen Zhongshan Urological Hospital,Shenzhen 518000)

机构地区：[1]深圳中山泌尿外科医院生殖医学中心,深圳518000

出　　处：《生殖医学杂志》2022年第1期6-12,共7页Journal of Reproductive Medicine

摘　　要：目的探讨多囊卵巢综合征(PCOS)患者拮抗剂方案促排卵过程中早发LH升高对IVF-ET临床结局的影响。方法回顾性分析2016年1月至2019年12月于我院生殖中心行拮抗剂方案IVF/ICSI助孕共650例PCOS患者的临床资料。根据促排卵期间给予拮抗剂后血清LH浓度不同分为2组,其中血清LH<10 U/L的患者为A组(n=475),血清LH≥10 U/L的患者为B组(n=175)。比较两组患者的基本临床资料和促排卵情况;比较两组新鲜胚胎移植周期妊娠结局;采用多元Logistic回归模型,分析拮抗剂方案促排卵过程中发生早发LH升高的高危影响因素。结果纳入研究的PCOS患者有26.92%(175/650)在添加拮抗剂后监测到了早发LH升高。两组间年龄、抗苗勒管激素(AMH)和体质量指数(BMI)比较均无显著差异(P>0.05),B组患者的基础FSH水平、基础LH水平、窦卵泡数(AFC)和不孕年限均显著高于A组(P<0.05);B组患者中有4例(2.29%)患者发生了部分卵泡的提早排卵或黄素化。两组间拮抗剂添加时机、Gn天数、Gn总量、扳机日内膜厚度、获卵数、MⅡ卵数、2PN数和优质胚胎数比较均无显著差异(P>0.05),而B组扳机日E_(2)、孕酮及LH水平均显著高于A组(P<0.05)。在新鲜胚胎移植周期中,两组间移植胚胎数、临床妊娠率和继续妊娠率比较均无显著差异(P>0.05)。多元Logistic回归分析发现,高的基础LH水平[OR=1.268,95%CI(1.206,1.334),P=0.000]和BMI[OR=1.126,95%CI(1.064,1.192),P=0.000]是PCOS患者拮抗剂方案促排卵过程中早发LH升高的危险因素,而年龄、不孕年限、AFC以及拮抗剂添加时机并不影响PCOS患者早发LH升高的发生(P>0.05)。结论PCOS患者拮抗剂方案发生早发LH升高不影响IVF-ET的临床结局,但是需要注意有早发排卵或黄素化的风险。Objective:To investigate the effect of premature LH elevation on IVF outcomes in patients with polycystic ovary syndrome(PCOS)undergone GnRH antagonist treatment.Methods:A total of 650 PCOS patients undergone IVF/ICSI with GnRH-antagonist protocol from January 1,2016 to December 31,2019 were retrospectively analyzed.The patients were divided the two groups depending on their LH level during controlled ovarian stimulation:group A with LH<10 U/L(n=475)and group B with LH≥10 U/L(n=175).The baseline characteristics,controlled ovarian stimulation parameters and outcomes of fresh embryo transfer were compared between the two groups.The multivariate logistic regression analysis was used to identify factors associated with premature LH elevation.Results:Among PCOS patients included in the study,26.92%(175/650)PCOS patients experience premature LH elevation after administration of GnRH antagonist.There were no significant differences in age,anti-Mullerian hormone(AMH)and body mass index(BMI)between groups(P>0.05).The basal FSH level,basal LH level,number of antral follicles count(AFC)and infertility years in group B were significantly higher than those in group A(P<0.05).Early ovulation or luteinization of some follicles occurred in 4 patients(2.29%)in group B.There were no significant differences in the timing of antagonist addition,number of days of Gn and total amount of Gn,endometrial thickness,number of oocytes retrieved,MⅡoocytes,2PN embryos and good-quality embryos between the two groups(P>0.05),while the levels of E_(2),progesterone and LH in group B were significantly higher than those in group A(P<0.05).In addition,the clinical pregnancy rate and ongoing pregnancy rate in the fresh embryo transfer cycle were comparable between groups(P>0.05).Multiple logistic regression analysis found that the higher basic LH level[OR=1.268,95%CI(1.206,1.334),P=0.000]and BMI[OR=1.126,95%CI(1.064,1.192),P=0.000]were the risk factors for the premature LH elevation in the process of ovulation induction with antagonist protocol

关 键 词：促性腺激素释放激素拮抗剂 多囊卵巢综合征 早发LH升高 

分 类 号：R711.6[医药卫生—妇产科学]