目的:探讨正常促性腺激素妇女超促排卯时晚卵泡期黄体生成素(LH)水平对体外受精(IVF)结局的影响.方法:正常促性腺激素妇女432个周期,于黄体中期开始采用促性腺激素释放激素激动剂(GnRHa)行垂体降调节后,应用卵泡刺激素(FSH)刺激卵巢的促排卵方案.当卵泡直径达14 mm时,添加hMG(FSH+hMG组),对照组不添加hMG(FSH组).hCG注射日测定血LH和雌二醇(E2)浓度.按照LH浓度,将FSH+hMG组分为4个亚组.结果:FSH+hMG组的hCG注射日E2浓度高于FSH组[(3 435.51±2 029.01)pg/ml和2 620.62±1 604.80)pg/ml,P＜0.05],胚胎移植数少于后者[(2.77±0.45)个和(2.22±0.46)个,P＜0.001].两组受精率、胚胎种植率和临床妊娠率无统计学差异(77.52%和78.31%,41.42%和41.68%,64.56%和62.64%,P均＞0.05);FSH+hMG组的4个亚组的受精率、胚胎种植率和临床妊娠率也无统计学差异(P＞0.05).结论:正常促性腺激素妇女超促排卯时,晚卵泡期血清LH在生理范围内以及在晚卵泡期适量添加LH,不会对IVF结局产生负面影响.
Objective: To evaluate the impact of the concentration of circulating luteinizing hormone (LH) in the late-follicle phase on the outcome of in vitro fertilization for normogonadotrophic women. Methods: Intracytoplasmic sperm injection treatment was conducted in 432 consecutive cycles of normogonadotrophic women. A stimulation protocol with mid-luteal gonadotropin-releasing hormone (GnRH) agonist down-regulation and ovarian stimulation with follicle stimulating hormone (FSH) was used in all cycles. hMG was added when a follicle of ≥14 mm was present (FSH+hMG group), not in the control group (FSH-alone). LH and oestradiol concentration in the serum on hCG day were detected. Based on LH levels, patients in the FSH+hMG group were again divided into four subgroups: LH≤1, 1<LH≤2, 2<LH≤3, and 3<LH≤10 IU/L. Results: Oestradiol concentration on the day of hCG injection in the FSH+hMG group was higher than that in the FSH-alone group [( 3 435.51± 2 029.01) pg/ml vs ( 2 620.62± 1 604.80) pg/ml, P< 0.05]. More embryos were transferred in the FSH-alone group than in the FSH+hMG group[( 2.77± 0.45) vs ( 2.22± 0.46), P< 0.001). Fertilization rate, implantation rate, and clinical pregnancy rate were similar between the FSH-alone group and the FSH+hMG group ( 77.52% vs 78.31%, 41.42% vs 41.68%, 64.56% vs 62.64%, P> 0.05), as well as among the four subgroups of the FSH+hMG group (P> 0.05). Conclusion: The adding of suitable amount of hMG and physiologically limited LH concentration in the late-follicle phase have no negative effect on the outcome of in vitro fertilization/intracytoplasmic sperm injection for normogonadotrophic women.
National Journal of Andrology
in vitro fertilization