GnRH拮抗剂方案促排卵过程中平均LH水平对妊娠结局的影响  

Effects of average LH levels during ovarian stimulation with GnRH antagonist protocol on pregnancy outcomes

作　　者：刘姗 马帅 李媛 LIU Shan;MA Shuai;LI Yuan(Medical Center for Human Reproduction,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020)

机构地区：[1]首都医科大学附属北京朝阳医院生殖医学中心,北京100020

出　　处：《生殖医学杂志》2022年第5期591-597,共7页Journal of Reproductive Medicine

基　　金：中国健康促进基金会2020辅助生殖中青年医生研究项目;北京市医院管理中心“青苗”计划项目(QML20200301)。

摘　　要：目的 评估GnRH拮抗剂方案促排卵过程中平均LH水平对新鲜周期移植和每取卵周期累积妊娠结局的影响。方法 回顾性分析2018年6月至2020年6月于北京朝阳医院生殖医学中心行体外受精-胚胎移植(IVF-ET)治疗的330例不孕症患者的临床资料,按照促排卵过程中平均LH水平三分位数进行分组,分为低LH组(小于纳入人群平均LH水平的第33位百分位数,n=110)、中LH组(处于纳入人群平均LH水平的第33~67位百分位数,n=109)和高LH组(大于纳入人群平均LH水平的第67位百分位数,n=111)。比较各组患者的基本临床特征、促排卵过程中的临床和实验室指标、新鲜移植周期与全胚胎冷冻患者首个解冻移植周期妊娠结局及每取卵周期的累积妊娠结局,并采用Logistic回归分析每取卵周期累积活产率的影响因素。结果 3组患者间不孕年限和不孕原因构成有统计学差异(P<0.05),其他基线特征均无统计学差异(P>0.05)。3组患者间平均LH水平、Gn启动剂量、Gn天数及总量、扳机日LH水平均有统计学差异(P<0.05),其中,高LH组的Gn启动剂量最低、刺激天数最短、Gn总量最少,而扳机日LH水平最高。评估卵巢反应性的指标卵泡输出率(FORT)、卵泡/卵母细胞指数(FOI)、卵巢敏感指数(OSI)均无统计学差异(P>0.05);3组间获卵数、受精数、2PN数、D3优质胚胎数等实验室结局指标亦无统计学差异(P>0.05)。低LH组、中LH组及高LH组患者新鲜周期移植的HCG阳性率分别为68.75%、74.07%和36.84%,组间比较有统计学差异,且中LH组最高(P<0.05);3组间临床妊娠率、继续妊娠率、活产率比较均无统计学差异(P>0.05),但中LH组各指标均相对较高。3组间全胚胎冷冻患者首个解冻移植周期和每取卵周期累积妊娠结局的各指标均无统计学差异(P>0.05)。Logistic回归分析显示,年龄和获卵数与每取卵周期累积活产率呈正相关(P<0.05);低LH组和高LH组每取卵周期累积活产�Objective:To evaluate the effects of average LH levels during ovarian stimulation with GnRH antagonist protocol on cumulative pregnancy outcomes of fresh embryo transfer cycle and per oocyte retrieval cycle.Methods:The clinical data of 330 infertile patients undergone IVF-ET treatment in the Medical Center for Human Reproduction, Beijing Chao-Yang Hospital from June 2018 to June 2020 were retrospectively analyzed. The patients were divided into three groups according to the tertile of average LH levels during ovarian stimulation: low LH group(below the 33;percentile of the average LH level of included patients),medium LH group(between 33;and 67;percentiles of the average LH level of included patients),and high LH group(above the 67;percentile of the average LH level of included patients). The basic clinical characteristics, clinical and laboratory indicators during ovarian stimulation, pregnancy outcomes of fresh embryo transfer cycle, the first frozen-thawed embryo transfer(FET) cycle of the patients with whole embryo freezing, and the cumulative pregnancy outcomes per oocyte retrieval cycle were compared. Logistic regression was used to analyze the influencing factors of cumulative live birth rate in each oocyte retrieved cycle.Results:There were significant differences in the number of infertile years and the infertile causes among the three groups(P<0.05),but there was no significant difference in other baseline characteristics(P>0.05). There were significant differences in average LH level, Gn initiation dose, Gn days and total amount, and LH level on trigger day among the three groups(P<0.05). Among them, the high LH group had the lowest Gn initiation dose, the shortest stimulation days, the lowest total amount of Gn, and the highest LH level on the trigger day. There was no significant difference in indicators for evaluating ovarian reactivity including follicle output rate(FORT),follicle/oocyte index(FOI) and ovarian sensitivity index(OSI)(P>0.05). There was no significant difference in the number of oocy

关 键 词：体外受精-胚胎移植 GNRH拮抗剂 黄体生成素 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]