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目的:探讨在高孕激素超促排卵方案中基础血黄体生成素(LH)水平对多囊卵巢综合征(PCOS)患者行体外受精/卵胞质内单精子显微注射(IVF/ICSI)治疗的临床结局的影响。方法:回顾性分析183例PCOS患者采用从早卵泡期开始使用安宫黄体酮(MPA)联合促性腺激素(Gn)的高孕激素超促排卵方案行IVF/ICSI治疗;根据基础LH水平分为3组,A组:0~5 IU/L,B组:5~10 IU/L,C组:>10 IU/L,分析3组患者在高孕激素超促排卵过程中不同血LH水平与控制性超促排卵特征及IVF临床结局的相关性。结果:3组在促排卵过程中LH水平均呈下降趋势,且在基础LH水平、中期LH水平、诱发排卵当日的LH水平及诱发排卵次日的LH水平3组间比较均有统计学差异(P<0.05),在扳机日LH水平波动于0.08~12.33 IU/L之间,无一例发生自发性LH峰;在获卵数、成熟卵数及获卵率A组与C组间有统计学差异(P<0.05),而成熟卵率、正常受精卵数、优质胚胎数及有效胚胎数3组间比较无统计学差异(P>0.05);后续的冻融胚胎移植(frozen-thawed embryo transfer,FET)周期结果表明,临床妊娠率、早期流产率及继续妊娠率组间比较均无统计学差异(P>0.05)。结论:高孕激素促排卵方案可有效预防PCOS患者行IVF/ICSI治疗的自发性LH峰发生,并且基础高LH水平未损害PCOS患者的卵子及胚胎质量,对其临床结局也无明显影响,因此高孕激素超促排卵方案是一种新的简单安全、高效的垂体非降调节超促排卵方案,但还需大样本多中心的随机对照试验进一步证实。
OBJECTIVE: To investigate the effect of basal blood LH (LH) levels in IVF / ICSI treatment in patients with polycystic ovary syndrome (PCOS) under high progestin hypersensitivity ovulation regimen The impact of clinical outcome. Methods: A retrospective analysis of 183 cases of PCOS patients with early pregnancy follicular phase using progesterone (MPA) combined with gonadotropin (Gn) high progesterone ovulation IVF / ICSI treatment; according to the basic LH levels were divided into 3 groups, A group: 0 ~ 5 IU / L, B group: 5 ~ 10 IU / L, C group:> 10 IU / L, analysis of 3 groups of patients with high progesterone during ovulation induction of different blood LH levels and Correlation between controlled ovarian hyperstimulation and IVF clinical outcome. Results: The LH levels of all three groups showed a decreasing trend during ovulation induction. There were significant differences among the three groups in basal LH level, mid-term LH level, LH level on the day of ovulation induction and LH level on the next day of ovulation induction P <0.05), LH level fluctuated between 0.08 ~ 12.33 IU / L on the trigger day, and no spontaneous LH peak occurred in one case. There was a statistically significant difference between the number of oocytes retrieved, the number of mature oocytes and the number of oocytes retrieved (P <0.05). There was no significant difference between the three groups (P> 0.05). The frozen-thaw embryo transfer (frozen-thaw embryo transfer) , FET) cycle results showed that clinical pregnancy rate, early miscarriage rate and continued pregnancy rate were no significant difference between the two groups (P> 0.05). CONCLUSION: High progesterone ovulation induction can effectively prevent the spontaneous LH peak of IVF / ICSI treatment in patients with PCOS, and the basic high LH level has no effect on the egg and embryo quality of PCOS patients and has no obvious effect on its clinical outcome Hyperprolactin hyperstimulation is a new simple, safe and effective pituitary non-hypothyroidism regimen of ovulation induction, but large sample multicenter randomized controlled trials to further confirm.