摘要
目的探讨黄体生成素(luteinizing hormone, LH)提前升高对应用促性腺激素释放激素拮抗剂灵活方案促排卵患者体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection, IVF/ICSI)鲜胚移植临床结局的影响。方法回顾性队列研究分析2016年1月至2021年9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患者资料。根据添加拮抗剂前LH水平将患者分为两组, A组:LH提前升高(添加拮抗剂前LH>10 U/L), 共65个周期;B组:添加拮抗剂前LH≤10 U/L, 按照年龄、不孕年限、抗苗勒管激素水平、体质量指数、窦卵泡计数与A组进行1∶3倾向评分匹配, 共193个周期。比较两组患者的一般情况、临床资料、胚胎实验室指标及临床结局。结果两组患者基线特征差异均无统计学意义(均P>0.05)。A、B两组患者基础LH水平、促性腺激素(gonadotropin, Gn)启动剂量、Gn使用总量、Gn使用时间、添加拮抗剂时Gn使用时间、扳机日雌二醇水平差异均无统计学意义(均P>0.05)。A组患者添加拮抗剂日LH水平[12.2(11.1, 17.5)U/L]、雌二醇水平[3 301.0(2 708.0, 4 275.0)pmol/L]及卵泡直径[14.0(12.6, 15.5)mm]均明显高于B组[3.5(2.2, 5.2)U/L、2 178.5(1 208.0, 3 218.0)pmol/L、13.0(12.0, 14.0)mm], 差异均有统计学意义(均P<0.001)。添加拮抗剂后A组LH水平迅速下降, 虽然A组添加拮抗剂后LH水平[3.4(2.0, 5.2)U/L]、扳机日LH水平[3.0(1.7, 4.7)U/L]仍高于B组[2.1(1.5, 3.3)U/L, P<0.001;2.1(1.4, 3.3)U/L, P=0.004], 但扳机日孕酮水平与B组比较差异无统计学意义(P>0.05)。两组患者获卵数、双原核受精率、优质胚胎率、囊胚形成率、移植日内膜厚度、移植胚胎数、移植囊胚占比、种植率差异均无统计学意义(均P>0.05)。两组患者临床妊娠率、早期流产率、活产率差异均无统计学意义(均P>0.05)。结论卵巢储备功能正常的
Objective To observe the effect of early elevation of luteinizing hormone(LH)with flexible gonadotropin-releasing hormone antagonist(GnRH-A)protocol on pregnancy outcomes of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)fresh embryo transfer.Methods A retrospective cohort study was conducted to analyze patients with normal ovarian reserve function who underwent IVF/ICSI with flexible GnRH-A protocol at the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to September 2021.According to the level of LH before antagonist addition,the patients were divided into two groups,group A:early elevation of LH(LH>10 U/L before the addition of antagonist,n=65),group B:the patients whose LH≤10 U/L before the addition of antagonist(n=193),which was matched with group A using the 1∶3 propensity score matching by age,duration of infertility,anti-Müllerian hormone,body mass index and antral follicle count.The general conditions,clinical data,embryonic laboratory indicators and clinical outcomes were compared between the two groups.Results There were no significant differences in the baseline characteristics between the two groups(all P>0.05).There were no significant differences in basic LH levels,gonadotropin(Gn)initiation dosage,total dosage and duration of Gn used,duration of Gn used when adding antagonists and estradiol(E2)level on the trigger day between group A and group B(all P>0.05).The LH level[12.2(11.1,17.5)U/L],E2 level[3301.0(2708.0,4275.0)pmol/L]and follicle diameter[14.0(12.6,15.5)mm]were significantly higher in group A than in group B[3.5(2.2,5.2)U/L,2178.5(1208.0,3218.0)pmol/L,13.0(12.0,14.0)mm]when adding antagonist(all P<0.001).The level of LH in group A decreased rapidly after adding antagonist,LH level in group A after antagonist application[3.4(2.0,5.2)U/L]and the LH level on the trigger day[3.0(1.7,4.7)U/L]were still higher than those in group B[2.1(1.5,3.3)U/L,P<0.001;2.1(1.4,3.3)U/L,P=0.004],the level of progesterone on the trigg
作者
黄江笛
杨如雪
董孝贞
李丹阳
徐影
张亚
孙丽君
Huang Jiangdi;Yang Ruxue;Dong Xiaozhen;Li Danyang;Xu Ying;Zhang Ya;Sun Lijun(Reproductive Medcine 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)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2023年第12期1244-1248,共5页
Chinese Journal of Reproduction and Contraception
