探讨拮抗剂方案中卵泡期低水平促黄体生成素对累计活产率的影响
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南京医科大学附属妇产医院

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江苏省卫计委指导性课题(LGY2018004);南京市医学重点科技发展项目(ZKX16063)


To Investigate the Effect of Low Levels of LH during Follicular Phase on Cumulative Live Birth Rate in GnRH Antagonist Protocol
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    摘要:

    目的:探讨拮抗剂方案促排卵过程中低水平促黄体生成素(luteinizing hormone,LH)对累计活产率(cumulative live birth rate,CLBR)的影响。方法:回顾性分析本中心693例采用拮抗剂方案且首次行体外受精-胚胎移植患者的取卵周期资料,将卵泡期最低LH水平≤0.8IU/L设为A组,卵泡期最低LH水平>0.8IU/L设为B组,分析比较两组的一般临床资料、实验室指标和妊娠结局。结果:A组的基础促卵泡生成素(follicle stimulating hormone,FSH)水平、基础LH水平、人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)日LH水平显著低于B组(P<0.05)。A组的促性腺激素(gonadotropin,Gn)使用天数、HCG日雌二醇(estradiol,E2)水平、HCG日孕酮(progesterone,P)水平、获卵数、可移植胚胎数明显高于B组(P<0.05)。但两组的CLBR均无统计学差异(P>0.05)。LH水平≤0.8IU/L频次的增加对累计活产率无明显影响(P>0.05)。应用多因素logistic回归分析,调整混杂因素后,显示卵泡期最低LH水平对CLBR无明显影响,而获卵数是CLBR的独立预测因子。结论:卵泡期低水平LH可以预测更多的获卵数,但对累计活产率无明显影响。

    Abstract:

    Objective: To investigate the effect of low levels of luteinizing hormone (LH) on the cumulative live birth rate (CLBR) during ovarian hyperstimulation in GnRH antagonist protocol. Methods: The data of oocytes retrieval cycle of 693 patients in our center who received GnRH antagonist protocol and underwent in vitro fertilization and embryo transfer for the first time were retrospectively analyzed. The lowest LH level≤0.8IU/L in follicular phase was set as group A, and the lowest LH level>0.8IU/L in follicular phase was set as group B. The general clinical data, laboratory indicators and pregnancy outcomes of the two groups were analyzed and compared. Results: The levels of basic FSH, basic LH and LH on human chorionic gonadotropin (HCG) injection day in group A were significantly lower than those in group B (P<0.05).Duration of gonadotropin (Gn), estradiol (E2) level and progesterone (P) level on HCG injection day, number of retrieved oocytes and number of transferable embryos in Group A were significantly higher than those in group B (P<0.05).However, there was no significant difference in CLBR between the two groups (P>0.05). The frequency of serum LH≤0.8 IU/L has no significant influence on the CLBR. After adjusting for confounding factors, multivariate logistic regression analysis showed that the lowest LH level at follicular phase had no influence on CLBR, and the number of retrieved oocytes was an independent predictor of CLBR. Conclusion: Low LH in follicular phase can predict more retrieved oocytes ,but it has no influence on cumulative live birth rate.

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  • 收稿日期:2020-06-22
  • 最后修改日期:2020-12-28
  • 录用日期:2022-02-25
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