多囊卵巢综合征患者拮抗剂使用前LH升高对IVF-ET结局的影响  

Effect of luteinizing hormone rise before use of GnRH-antagonist on IVF-ET outcomes in patients with polycystic ovary syndrome

作　　者：赵伟娥 刘晓娉 陈攀宇[1] 梁晓燕[1] 李晶洁[1] ZHAO Wei-e;LIU Xiao-ping;CHEN Pan-yu;LIANG Xiao-yan;LI Jing-jie(Reproductive Medicine Research Center,The Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou510000)

机构地区：[1]中山大学附属第六医院生殖中心,广州510000

出　　处：《生殖医学杂志》2023年第4期514-520,共7页Journal of Reproductive Medicine

基　　金：国家重点研发计划(2021YFC2700400)。

摘　　要：目的探讨多囊卵巢综合征(PCOS)患者行拮抗剂固定方案促排卵时,拮抗剂使用前黄体生成素(LH)升高对促排卵及妊娠结局的影响。方法回顾性分析2015年1月至2021年12月在我院生殖医学研究中心行IVF/ICSI-ET助孕治疗时采用拮抗剂固定方案促排卵的784例PCOS患者的784个周期的临床资料,根据拮抗剂使用前LH水平分为升高组(LH>10 U/L,147个周期)与正常组(LH≤10 U/L,637个周期)。比较两组患者的一般资料、促排卵结局、胚胎移植情况及鲜胚移植周期的妊娠结局,并采用多重线性回归分析评价拮抗剂使用前LH水平的影响因素。结果两组患者的年龄、体质量指数(BMI)、不孕类型、受精方式比较均无显著性差异(P>0.05)。LH升高组的抗苗勒管激素(AMH)、基础FSH、基础LH、基础E 2水平均显著高于正常组(P<0.05)。LH升高组的Gn天数、Gn总剂量均显著低于正常组(P<0.01),获卵数、取消新鲜周期移植率及预防OHSS取消移植率均显著高于正常组(P<0.05)。LH升高组的2PN率显著高于正常组(P<0.05);两组间可利用胚胎率、优质胚胎率与囊胚形成率比较均无显著性差异(P>0.05)。LH正常组鲜胚移植206个周期,升高组鲜胚移植28个周期;两组间移植胚胎数、HCG阳性率、临床妊娠率及活产率比较均无显著性差异(P>0.05)。多重线性回归分析结果显示,基础LH水平与拮抗剂使用前E 2水平显著影响拮抗剂使用前的LH水平(P<0.001)。结论行拮抗剂固定方案促排卵的PCOS患者中,拮抗剂使用前LH升高并不明显影响胚胎发育情况及鲜胚移植周期的妊娠结局;但拮抗剂使用前LH升高患者存在卵巢反应性更高的特点,值得临床医生关注。Objective:To investigate the effect of premature luteinizing hormone(LH)rise before use of GnRH-antagonist(GnRH-ant)on the outcomes of controlled ovarian stimulation(COS)with GnRH-ant fixation protocol and fresh embryo transfers in patients with polycystic ovary syndrome(PCOS).Methods:The clinical data of 784 PCOS patients(784 cycles)who underwent the GnRH-ant fixation ovarian stimulation protocol at the Reproductive Medicine Center of the Sixth Hospital of Sun Yat-sen University from January 2015 to December 2021 were retrospectively analyzed.According to the LH levels before use of GnRH-ant,the cycles were divided into the LH rise group(LH>10 U/L,147 cycles)and the normal LH group(LH≤10 U/L,637 cycles).The general data,COS outcomes,pregnancy outcomes of fresh embryo transfer cycle were compared between the two groups,and multiple linear regression analysis was used to evaluate the influencing factors of premature LH rise before use of GnRH-ant.Results:There were no significant differences in age,body mass index(BMI),infertility type and fertilization type between the two groups(P>0.05).The levels of anti-Mullerian hormone(AMH),basal FSH,basal LH and basal E 2 in the LH rise group were significantly higher than those in the normal LH group(P<0.05).The number of days and total dose of Gn used in the LH rise group were significantly lower than those in the normal LH group(P<0.01),and the number of oocytes retrieved,the cancellation rate of fresh embryo transfer cycle and the cycle cancellation rate for preventing OHSS were significantly higher than those in the normal LH group(P<0.05).The 2PN rate in the LH rise group was significantly higher than that in the normal LH group(P>0.05).There were no significant differences in the available embryo rate,high-quality embryo rate and blastocyst formation rate between the two groups(P>0.05).There were 206 fresh embryo transfer cycles in the normal LH group and 28 fresh cycles in the LH rise group.There were no significant differences in the number of embryos transferred

关 键 词：多囊卵巢综合征 LH升高 拮抗剂固定方案 妊娠结局 

分 类 号：R771.6[医药卫生—眼科]