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目的探讨卵巢反应正常者超促排卵过程中添加黄体生成素(LH)对体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析2014年1月至2016年1月汕头市中心医院生殖中心接受IVF-ET治疗的360例卵巢反应正常的不孕患者的临床资料,研究对象均于月经第3~5天行重组人促卵泡激素(r-FSH)促超排卵,当卵泡最大直径达14 mm时,按LH水平分为3组,1组:LH<1 U/L,2组:1 U/L≤LH<2 U/L,3组:LH≥2 U/L。每组再分为A组:继续使用r-FSH至人绒毛膜促性腺激素(HCG)注射日;B组:每日添加人绝经期促性腺激素(HMG);C组:每日添加r-LH。比较各组的临床结局。结果 3组中不添加LH的A组中A1组的促性腺激素(Gn)时间,r-FSH用量,流产率高于A2、A3组;妊娠率A1、A2低于A3组,差异有统计学意义(P<0.05)。小组内A1组促性腺激素r-FSH用量、Gn时间、流产率显著高于B1、C1组,受精率及妊娠率显著低于B1、C1组,差异有统计学意义(P<0.05);A1、B1、C1组3组间添加LH日及HCG日血清LH水平、获卵数差异均无统计学意义(P>0.05)。A2组妊娠率显著低于B2、C2组,r-FSH用量、Gn时间、获卵数、流产率、添加LH日及HCG日血清LH水平差异均无统计学意义(P>0.05)。A3、B3、C3组间各项指标差异均无统计学意义(P>0.05)。结论对卵巢反应正常者,降调时LH水平过低影响临床结局;卵泡中晚期在LH<2 U/L时添加r-LH可提高妊娠率,尤其血清LH<1 U/L时添加r-LH可获较好的临床结局,LH≥2 U/L时不能从添加r-LH中获益。在相同LH水平时添加HMG和r-LH疗效无差异。
Objective To investigate the effect of luteinizing hormone (LH) supplementation on the outcome of IVF-ET in ovariectomized patients with normal ovarian response. Methods The clinical data of 360 cases of infertility patients with ovarian response who underwent IVF-ET treatment at the Reproductive Center of Shantou Central Hospital from January 2014 to January 2016 were retrospectively analyzed. The subjects were all reformed on the 3rd to 5th days of menstruation. Human follicle-stimulating hormone (r-FSH) promoted ovulation. When the maximum follicle diameter reached 14 mm, the levels of LH were divided into three groups. Group 1: LH <1 U / L, group 2: 2 U / L, 3 groups: LH ≥ 2 U / L. Each group was further divided into group A: continuous use of r-FSH on the day of human chorionic gonadotropin (HCG) injection; group B: daily addition of human menopausal gonadotropin (HMG); group C: daily addition of r- LH. The clinical outcomes of each group were compared. Results The Gn time, the amount of r-FSH and the abortion rate of group A1 were higher in group A1 than those in group A2 and A3; the pregnancy rates A1 and A2 were lower than those in group A3 Significance (P <0.05). The dosage of gonadotropin r-FSH, Gn time and abortion rate in group A1 were significantly higher than those in group B1 and C1, and the fertilization rate and pregnancy rate were significantly lower than those in group B1 and C1 (P <0.05). A1 There was no significant difference in the number of oocytes between the B1 and C1 groups (P> 0.05). The pregnancy rate in group A2 was significantly lower than that in group B2 and C2 (P> 0.05). There was no significant difference in the level of r-FSH, Gn time, number of oocytes retrieved, abortion rate, There was no significant difference in the indexes between A3, B3 and C3 (P> 0.05). Conclusions For patients with normal ovarian response, low serum LH levels may affect the clinical outcome. In the late stage of follicular injection, r-LH may increase the pregnancy rate when LH is less than 2 U / L, especially if the serum LH is less than 1 U / L. LH can be a better clinical outcome, LH ≥ 2 U / L can not benefit from the addition of r-LH. There was no difference in the effect of adding HMG and r-LH at the same LH level.