拮抗剂灵活方案添加拮抗剂后平均LH水平对IVF/ICSI鲜胚移植临床结局及累积活产率的影响  

Influence of mean LH levels after adding GnRH antagonists using a flexible GnRH antagonist protocol on clinical outcomes of IVF/ICSI fresh embryo transfer

作　　者：黄江笛 张彩华 董孝贞[2] 杨如雪 张贺博 胡继君[1] 张俊韦 刘端 管一春[1] 孙丽君[1] Huang Jiangdi;Zhang Caihua;Dong Xiaozhen;Yang Ruxue;Zhang Hebo;Hu Jijun;Zhang Juwei;Liu Duan;Guan Yichun;Sun Lijun(Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Ultrasound Department of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Gynecology and Obstetrics Department of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院生殖医学中心,郑州450052 [2]郑州大学第三附属医院超声科,郑州450052 [3]郑州大学第三附属医院妇产科,郑州450052

出　　处：《中华生殖与避孕杂志》2024年第3期229-236,共8页Chinese Journal of Reproduction and Contraception

基　　金：国家重点研发计划(2021YFC2700602)。

摘　　要：目的探讨应用促性腺激素释放激素拮抗剂(gonadotropin-releasing hormone antagonis,GnRH-A)灵活方案促排卵添加GnRH-A后黄体生成素(luteinizing hormone,LH)水平对卵巢储备功能正常患者体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)鲜胚移植临床结局及累积活产率的影响。方法回顾性队列研究分析2016年1月至2021年6月期间在郑州大学第三附属医院生殖医学中心采用拮抗剂灵活方案促排卵后行IVF/ICSI的卵巢储备功能正常的685例患者资料。采用四分位数法以添加拮抗剂后患者每次监测血清LH水平(根据卵泡生长速度及患者需要,通常为2次)直至扳机日血清LH水平的平均值进行分组,分为A组(小于纳入人群平均LH水平的第25百分位数,LH<1.25 U/L,n=166)、B组(处于纳入人群平均LH水平的第25~50百分位数,1.25 U/L≤LH<1.91 U/L,n=174)、C组(处于纳入人群平均LH水平的第50~75百分位数,1.91 U/L≤LH<2.85 U/L,n=171)和D组(大于纳入人群平均LH水平的第75百分位数,2.85 U/L≤LH≤7.55 U/L,n=174)。比较4组患者的一般情况、临床资料、胚胎实验室指标、鲜胚移植周期临床结局指标及累积活产率。结果经多因素线性回归矫正混杂因素后,C组患者的优质胚胎数、囊胚形成率显著高于A组,差异具有统计学意义(B=0.600,95%CI:0.086~1.114,P=0.022;B=0.134,95%CI:0.052~0.216,P=0.001)。D组患者的优质胚胎数、可利用胚胎数、囊胚形成率显著高于A组,差异具有统计学意义(B=0.771,95%CI:0.259~1.284,P=0.003;B=0.730,95%CI:0.205~1.255,P=0.007;B=0.085,95%CI:0.003~0.167,P=0.042)。经多因素logistic回归后,A组患者与B、C、D组患者的活产率差异无统计学意义(P>0.05)。D组患者的累积活产率显著高于A组患者,差异具有统计学意义(aOR=2.439,95%CI:1.169~4.974,P=0.014)。结论在卵巢储备功能正常的患者中应用GnRH-A灵活方案促排卵,添加GnRH-A后平均LH水平对鲜胚移�Objective To investigate the effect of luteinizing hormone(LH)levels on the clinical outcome and cumulative live birth rate of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)fresh embryo transfer in patients with normal ovarian reserve function after application of a flexible protocol of gonadotropin-releasing hormone antagonist(GnRH-A)to promote ovulation with the addition of GnRH-A.Methods A retrospective cohort study was conducted to analyze the data of 685 patients with normal ovarian reserve function who underwent IVF/ICSI after ovulation induction with antagonist flexible regimen between January 2016 and June 2021 at the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University.The quartile method was used to group patients after the addition of the antagonist by the mean value of serum LH each time they were monitored(usually twice,depending on the rate of follicular growth and patients'need)until the day of the trigger,and were divided into group A(smaller than the 25th percentile of the mean LH level of the included population,LH<1.25 U/L,n=166),group B(in the 25th to 50th percentile of the mean LH level of the included population,1.25 U/L≤LH<1.91 U/L,n=174),group C(in the 50th to 75th percentile of the mean LH level of the included population,1.91 U/L≤LH<2.85 U/L,n=171),and group D(greater than the 75th percentile of the mean LH level of the included population,2.85 U/L≤LH≤7.55 U/L,n=174).The general condition,clinical data,embryo laboratory indices,clinical outcome indices of fresh embryo transfer cycle and cumulative live birth rate were compared among the 4 groups.Results After correcting for confounding factors by multifactorial linear regression,the number of high-quality embryos and the rate of blastocyst formation of patients in group C were significantly higher than those in group A,and the differences were statistically significant(B=0.600,95%CI:0.086-1.114,P=0.022;B=0.134,95%CI:0.052-0.216,P=0.001).The number of high-quality embryos,the num

关 键 词：卵巢储备功能 促性腺激素释放激素拮抗剂灵活方案 黄体生成素 临床结局 

分 类 号：R714.8[医药卫生—妇产科学]