拮抗剂方案中卵泡期黄体生成素变化幅度对不孕症患者卵巢反应性及妊娠结局的影响  

Effect of luteinizing hormone change amplitude in follicular phase on infertilitypatients’ ovarian response and pregnancy outcome ingonadotropin-releasing hormone antagonist protocol

作　　者：安静 石盼盼 张祥 陈宥艺 杨洋 赵静 AN Jing;SHI Panpan;ZHANG Xiang;CHEN Youyi;YANG Yang;ZHAO Jing(Center for Reproductive Medicine,Xi’an People’s Hospital/Xi’an Fourth Hospital,Xi’an,Shanxi 710004,China)

机构地区：[1]西安市人民医院/西安市第四医院生殖医学中心,西安710004

出　　处：《重庆医学》2024年第9期1365-1370,共6页Chongqing medicine

基　　金：西安市人民医院(西安市第四医院)院级孵化基金项目(FZ-70)。

摘　　要：目的分析卵巢正常反应不孕症患者拮抗剂方案控制性超促排卵(COH)过程中卵泡期黄体生成素(LH)变化幅度对卵巢反应性及新鲜周期移植妊娠结局的影响。方法选取2019年1月至2021年12月于该院生殖医学中心行体外受精-胚胎移植(IVF-ET)治疗的277例不孕症患者,按照COH第4天LH水平较COH用药前变化幅度的三分位数将患者分为高LH组(n=91)、中LH组(n=93)和低LH组(n=93)。比较各组患者的基本临床特征、COH过程中的外源性促性腺激素(Gn)使用情况、不同时期激素水平、卵巢反应性指标、实验室结局及新鲜周期移植妊娠结局。结果3组年龄、不孕年限、不孕类型、基础卵泡刺激素(FSH)、雌二醇、睾酮水平均无明显差异(P>0.05)。高LH组Gn时间最短,Gn总量和启动剂量最少,外源性Gn刺激后雌二醇水平、卵巢敏感指数(OSI)、获卵数、成熟卵(MII)卵子数、双原核受精数、成胚数、优质胚胎数均最高,与其他两组比较,差异均有统计学意义(P<0.016);3组新鲜周期移植的临床妊娠率、生化妊娠率及早期流产率均无明显差异(P>0.05)。结论在卵巢正常反应不孕症患者拮抗剂方案COH的过程中,卵泡期LH下降幅度大可在更短时间内获取更好的胚胎数量及质量,但对患者新鲜周期移植妊娠结局无影响。Objective To analyze the effect of luteinizing hormone(LH)change amplitude in follicular phase on ovarian response and pregnancy outcome after fresh embryo transfer cycle in infertility patients with normal ovarian function during controlled ovarian hyperstimulation(COH)with antagonist protocol.Methods A total of 277 infertility patients who underwent in vitro fertilization and embryo transfer(IVF-ET)in the Center for Reproductive Medicine of this hospital from January 2019 to December 2021 were selected.Patients were divided into the high LH group(n=91),medium LH group(n=93)and low LH group(n=93)according to the tertiles of changes between LH level on the fourth day of COH and basal LH level before COH administration.The basic clinical features,use of exogenous gonadotropin(Gn)during COH,hormone levels at different periods,indexes of ovarian response,laboratory outcomes and pregnancy outcomes during fresh embryo transfer cycle were compared among all groups.Results There was no significant difference in age,infertility duration,infertility types,basal follicle stimulating hormone(FSH),estradiol and testosterone levels among the three groups(P>0.05).The duration of use of Gn in the high LH group was the shortest,the total amount and initiation dose of Gn was the smallest,and the estradiol level,ovarian sensitivity index(OSI),numbers of oocytes,metaphase II(MII)oocytes,diprokaryotic fertilization,embryo formation and high-quality embryos were the highest after exogenous Gn stimulation,and the differences were statistically significant compared with the other two groups(P<0.016).There was no significant difference in the clinical pregnancy rate,biochemical pregnancy rate and early miscarriage rate during fresh embryo transfer cycle among the three groups(P>0.05).Conclusion The infertility patients with normal ovarian function who have a large decrease in LH level during COH with antagonist protocol can obtain better embryo quantity and quality,but there was no effect on the pregnancy outcome during fresh embryo tra

关 键 词：受精 体外 促性腺激素释放激素拮抗剂 黄体生成素 卵巢反应性 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]