IVF促排卵过程中GnRH拮抗剂添加日LH水平对助孕结局的影响  

The effect of LH level on the day of GnRH antagonist administration upon the outcomes of IVF-ET

作　　者：李桂桂 吴颖 张铭[1] LI Guigui;WU Ying;ZHANG Ming(Reproductive Medicine Center,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院生殖医学中心,武汉430071

出　　处：《中国药师》2024年第4期588-594,共7页China Pharmacist

基　　金：武汉大学中南医院基础-临床医学转化共享平台联合基金项目(ZNLH202206)。

摘　　要：目的 探索体外受精-胚胎移植技术(IVF-ET)助孕过程中促性腺激素释放激素(GnRH)拮抗剂添加日血黄体生成素(LH)水平对妊娠结局和胚胎质量的影响。方法 回顾性分析2018年1月至2022年12月于武汉大学中南医院生殖医学中心接受拮抗剂方案常规IVF-ET治疗且预期卵巢正常反应的女性不孕症患者资料,根据其拮抗剂添加日LH水平进行分组,比较各组临床妊娠率、着床率、卵子成熟度、受精率、卵裂率、2原核胚胎比率、D3优质胚胎率、囊胚形成率,并绘制受试者工作特征(ROC)曲线评估LH水平对临床妊娠的预测价值。结果 研究共纳入188例患者,其拮抗剂添加日LH水平的中位值为3.79(2.48,6.14)mIU/mL。当LH <2.48 mIU/mL时鲜胚移植的临床妊娠率和着床率均最低(P <0.05),而LH> 6.14 mIU/mL时则具有最高的临床妊娠率和着床率(P <0.01),但各组之间的配子和胚胎发育参数差异无统计学意义(P>0.05)。ROC曲线下面积为0.678,LH水平对预测临床妊娠具有一定的准确性。结论 控制性超促排卵过程中LH水平高于6.14 mIU/mL时使用拮抗剂可获得最优的临床妊娠结局。Objective To investigate the effect of luteinising hormone(LH)level on the day of gonadotropin releasing hormone(GnRH)antagonist administration upon the outcomes of pregnancy and embryo quality during in vitro fertilization-embryo transfer(IVF-ET)assisted conception.Methods The data of female infertility patients who received routine IVF-ET treatment with antagonist regimen and expected to have normal ovarian response at the Reproductive Medicine Center,Zhongnan Hospital of Wuhan University,from January 2018 to December 2022 were retrospectively analyzed,and the patients were grouped according to their LH levels on the day of GnRH antagonist administration,the clinical pregnancy rate,implantation rate,egg maturity,fertilization rate,cleavage rate,2 Prokaryotic embryo ratio,D3 high quality embryo rate and blastocyst formation rate between the groups were compared,and the receiver operating characteristic(ROC)curves were plotted to evaluate the predictive value of the LH levels for the clinical pregnancies.Results A total of 188 patients were included in the study,and the median LH level on the day of GnRH antagonist administration was 3.79(2.48,6.14)mIU/mL.The clinical pregnancy rate and implantation rate of fresh embryo transfer were the lowest when LH<2.48 mIU/mL(P<0.05),while the clinical pregnancy rate and implantation rate were the highest when LH>6.14 mIU/mL,and the difference was statistically significant(P<0.01),but there was no statistical difference in gamete and embryonic development parameters between the groups(P>0.05).The area under the ROC curve was 0.678,which means LH level has a certain degree of accuracy in predicting clinical pregnancy.Conclusion The use of antagonists with LH levels higher than 6.14 mIU/mL during controlled ovarian hyperstimulation led to the best clinical pregnancy outcome.

关 键 词：控制性超促排卵 促性腺激素释放激素拮抗剂 临床妊娠率 黄体生成素水平 

分 类 号：R714.8[医药卫生—妇产科学]