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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (12): 31-38.doi: 10.6040/j.issn.1671-7554.0.2022.0693

• • 上一篇    

扳机日及其后添加重组人促黄体激素对黄体期长方案助孕结局的影响

韩晓婷1,2,高文丽1,3,王婷1,赵君利1,4   

  1. 1.宁夏医科大学总医院生殖医学中心, 宁夏 银川 750004;2.江门市妇幼保健院生殖医学中心, 广东 江门 529020;3.西安市第四医院生殖医学中心, 陕西 西安 710005;4.宁夏医科大学教育部生育力保持重点实验室, 宁夏 银川 750004
  • 发布日期:2022-12-01
  • 通讯作者: 赵君利. E-mail:zhaojunli6812@163.com
  • 基金资助:
    2015默克雪兰诺中国生殖医学基金(MerckSerono_CREATE20150170)

Effects of recombinant human luteinizing hormone addition on trigger day and afterwards on assisted pregnancy outcomes of long-acting protocol in luteal phase

HAN Xiaoting1,2, GAO Wenli1,3, WANG Ting1, ZHAO Junli1,4   

  1. 1.Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China;
    2. Reproductive Medicine Center, Jiangmen Maternal and Child Healthcare, Jiangmen 529020, Guangdong, China;
    3. Reproductive Medicine Center, Xian Fourth Hospital, Xian 710005, Shaanxi, China;
    4. Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan 750004, Ningxia, China
  • Published:2022-12-01

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摘要： 目的 探讨扳机日及其后添加重组人黄体生成素(r-hLH)对体外受精和卵胞浆内精子注射-胚胎移植(IVF/ICSI-ET)结局的影响。 方法 回顾性分析2013年1月至2018年10月于宁夏医科大学总医院生殖医学中心行黄体期长效长方案且扳机日血清黄体生成素(LH)水平<1.2 IU/L的患者的临床资料,共912个周期,根据扳机日、取卵日、移植日是否单点或多点添加r-hLH分为未添加组(n=483)、添加组(n=429);根据是否活产分为非活产组(n=546)、活产组(n=366)。比较各组临床特征和助孕结局,采用二元 Logistic回归分析影响r-hLH添加及活产率的因素。 结果 添加组临床妊娠率、活产率、胚胎种植率、多胎妊娠率、早产率、流产率均高于未添加组,但差异均无统计学意义(P均>0.05);添加组卵巢过度刺激综合征(OHSS)发生率(3.26%)低于未添加组(8.28%),差异有统计学意义(P=0.001)。二分类Logistics回归分析显示,高水平促性腺激素(Gn)启动日LH(OR:1.597,95%CI:1.313~1.944, P<0.001)、高水平扳机日LH(OR:2.361,95%CI:1.304~4.275, P=0.005)及高OHSS发生率(OR:2.514,95%CI:1.140~5.545, P=0.022)是未添加r-hLH的危险因素。高龄(OR:1.042,95%CI:1.009~1.076, P=0.001)、高BMI指数(OR:1.060,95%CI:1.015~1.106, P=0.011)是低活产率的危险因素,移植2枚胚胎是低活产率的保护因素(OR=0.554,95%CI:0.404~0.761, P<0.001)。 结论 长方案降调相对过度的患者扳机日及其后添加r-hLH可达到理想的助孕结局。

关键词: 体外受精-胚胎移植, 重组人黄体生成素, 黄体支持, 妊娠结局

Abstract: Objective To investigate the effects of addition of recombinant human luteinizing hormone(r-hLH)on trigger day and afterwards on the outcomes of in vitro fertilization and intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET). Methods The clinical data of 912 cycles of serum luteinizing hormone(LH)level <1.2 IU/L on trigger day of long-acting protocol in luteal phase treated in the Reproductive Medicine Center of General Hospital of Ningxia Medical University during Jan. 2013 and Oct. 2018 were retrospectively analyzed. According to whether r-hLH was added on trigger day, oocyte retrieval day, and transplant day, the patients were divided into addition group(n=483)and non-addition group(n=429). According to whether they had live births, they were divided into non-live birth group(n=546)and live birth group(n=366). The clinical characteristics and pregnancy outcomes were compared and analyzed. The influencing factors of r-hLH addition and live birth rate were analyzed with binary Logistic regression. Results The clinical pregnancy rate, live birth rate, embryo implantation rate, multiple pregnancy rate, preterm birth rate, and abortion rate were higher in the addition group, but the difference was not statistically significant(all P>0.05). The incidence of ovarian hyperstimulation syndrome(OHSS)was lower in the addition group than in the non-addition group(3.26% vs 8.28%, P=0.001). Binary Logistic regression showed that high level of LH on gonadotropins(Gn)initiation day(OR: 1.597, 95%CI: 1.313-1.944, P<0.001), high level of LH on initiation day(OR: 2.361, 95%CI: 1.304-4.275, P=0.005)and high incidence of OHSS(OR: 2.514, 95%CI: 1.140-5.545, P=0.022)were risk factors of non-addition of r-hLH. Advanced age(OR: 1.042, 95%CI: 1.009-1.076, P=0.001)and high body mass index(BMI)(OR: 1.060, 95%CI: 1.015-1.106, P=0.011)were risk factors of low live birth rate, while transfer of two embryos was a protective factor(OR=0.554, 95%CI: 0.404-0.761, P<0.001). Conclusion Addition of r-hLH on trigger day and afterwards in patients with relatively excessive downregulation of long protocol can achieve satisfactory assisted pregnancy outcomes.

Key words: In vitro fertilization-embryo transfer, Recombinant human luteinizing hormone, Luteal support, Assisted pregnancy outcome

中图分类号: 

  • R711.74
[1] 杨静薇, 邓成艳, 黄学锋, 等. 中华医学会生殖医学分会2018年度辅助生殖技术数据报告[J]. 生殖医学杂志, 2021, 30(4): 419-425. YANG Jingwei, DENG Chengyan, HANG Xuefeng, et al. Annual report on assisted reproductive technology of Chinese Society of Reproductive Medicine in 2018 [J]. Journal of Reproductive Medicine, 2021, 30(4): 419-425.
[2] 白诗雨, 张建平. 黄体支持在复发性妊娠丢失中的作用[J]. 中国实用妇科与产科杂志, 2021,37(4): 427-431. BAI Shiyu, ZHANG Janping. Role of luteal support in recurrent pregnancy loss [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2021, 37(4): 427-431.
[3] 夏容, 杨盼, 李建军, 等. 早卵泡期长方案促排卵过程中添加LH制剂对IVF/ICSI临床结局的影响[J]. 中国医药导报, 2020, 17(3): 90-93. XIA Rong, YANG Pan, LI Jianjun, et al. Effect of human luteinizing hormone on clinical outcome during in-vitro fertilization or intracytoplasmic sperm injection-embryo transfer [J]. China Medical Herald, 2020, 17(3):90-93.
[4] 王慧慧, 马倩莹, 邓颖. 黄体期长效长方案促性腺激素释放激素激动剂剂量对IVF/ICSI临床结局的影响[J]. 中华生殖与避孕杂志, 2022, 42(4): 345-349. WANG Huihui, MA Qianying, DENG Ying. Effect of GnRH-a dosage on IVF/ICSI clinical outcomes in luteal phase long protocol [J]. Chinese Journal of Reproduction and Contraception, 2022, 42(4): 345-349.
[5] 殷莉, 朱桂金. 控制性超排卵中黄体生成素的过度抑制和黄体生成素预处理[J]. 生殖医学杂志, 2013, 22(10): 749-752. YIN Li, ZHU Guijin. Excessive suppression of luteinizing hormone and luteinizing hormone pretreatment in controlled ovarian stimulation [J]. Journal of Reproductive Medicine, 2013, 22(10): 749-752.
[6] Alviggi C, Clarizia R, Mollo A, et al. Who needs LH in ovarian stimulation? [J]. Reprod Biomed Online, 2011,Suppl1: S33-S41. doi: 10.1016/S1472-6483(11)60007-2.
[7] Plewes MR, Krause C, Talbott HA, et al. Trafficking of cholesterol from lipid droplets to mitochondria in bovine luteal cells: acute control of progesterone synthesis [J]. FASEB J, 2020, 34(8): 10731-10750.
[8] Bildik G, Akin N, Esmaeilian Y, et al. hCG Improves luteal function and promotes progesterone output through the activation of JNK pathway in the luteal granulosa cells of the stimulated IVF cycles [J]. Biol Reprod, 2020,102(6): 1270-1280.
[9] Giri SK, Nayak BL, Mohapatra J. Thickened endometrium: when to intervene? a clinical conundrum [J]. J Obstet Gynaecol India, 2021, 71(3): 216-225.
[10] 李红真. 雌、孕激素暴露时间及其血清浓度对人工周期冻融胚胎移植结局的影响[J]. 中华生殖与避孕杂志, 2021, 41(3): 257-263. LI Hongzhen. Effects of estrogen and progesterone exposure time and serum concentrations on the outcomes of frozen-thawed embryo transfer in artificial cycles [J]. Chinese Journal of Reproduction and Contraception, 2021, 41(3): 257-263.
[11] 呼琳, 宋冰冰, 郝好英, 等. 血清雌二醇、25(OH)维生素D水平与冻融单囊胚移植临床结局关系[J]. 中国计划生育学杂志, 2021, 29(7): 1439-1443. HU Lin, SONG Bingbing, HAO Haoying, et al. Correlation between serum estradiol and 25(OH)D levels of the women and the clinical outcomes after single frozen-thawed blastocyst transfer[J]. Chinese Journal of Family Planning, 2021, 29(7): 1439-1443.
[12] 梁秀霞, 刘丽, 贾玲玲. 早卵泡期和晚卵泡期添加黄体生成素对多囊卵巢综合征GnRH-a长方案卵巢慢反应患者临床结局的影响[J]. 临床和实验医学杂志, 2020, 19(4): 397-399. LIANG Xiuxia, LIU Li, JIA Lingling. Effects of luteinizing hormone at different stages on clinical outcomes of polycystic ovary syndrome patients with suboptimal ovarian response to GnRH-a long protocol [J]. Journal of Clinical and Experimental Medicine, 2020, 19(4): 397-399.
[13] 杨洋, 初子琪, 李丽, 等. 年龄对体外受精-胚胎移植患者累积活产率的影响[J]. 中华中医药杂志, 2021, 36(9): 5505-5509. YANG Yang, CHU Ziqi, LI Li, et al. Effects of age on the cumulative live birth rates in patients undergoing in vitro fertilization-embryo transfer [J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2021, 36(9): 5505-5509.
[14] Li S, Hu L, Zhang C. Effect of chronological age of patients with diminished ovarian reserve on in vitro fertilization outcome [J]. J Obstet Gynaecol, 2021, 42(4): 654-657.
[15] 马龙, 韩乐, 马翔, 等. 女性体重指数对IVF/ICSI周期结局的影响[J]. 南京医科大学学报(自然科学版), 2022, 42(1): 71-74. MA Long, HAN Le, MA Xiang, et al. Effects of female body mass index on the outcomes of IVF/ICSI cycles[J]. Journal of Nanjing Medical University(Natural Sciences), 2022, 42(1): 71-74.
[16] Chen H, Li J, Cai S, et al. Impact of body mass index(BMI)on the success rate of fresh embryo transfer in women undergoing first in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)treatment [J]. Int J Obes(Lond), 2022, 46(1): 202-210.
[17] 杨超, 刘兰兰, 洪玉珍. 15 022例体外受精-胚胎移植周期的临床结局分析[J]. 中国优生与遗传杂志, 2019, 27(9): 1128-1130. YANG Chao, LIU Lanlan, HONG Yuzhen. Follow-up of patient undergoing in vitro fertilization-embryo transfer: a case study of 15022 [J]. Chinese Journal of Birth Health & Heredity, 2019, 27(9): 1128-1130.
[18] 叶圆圆, 颜晓红, 李友筑. 体外受精/卵胞浆内单精子注射中鲜胚移植妊娠结局的影响因素分析[J]. 吉林大学学报(医学版), 2022, 48(2): 454-461. YE Yuanyuan, YAN Xiaohong, LI Youzhu. Analysis on related factors of pregnancy outcome after fresh embryo transfer in in-vitro fertilization/intra-cytoplasmic sperm injection [J]. Journal of Jilin University(Medicine Edition), 2022, 48(2): 454-461.
[19] 黄玲, 黄冬梅, 黄映琴, 等. 关于高龄女性助孕技术移植胚胎数目的伦理思考[J]. 中华生殖与避孕杂志, 2020, 40(7): 610-613. HUANG Ling, HUANG Dongmei, HAUNG Yingqin, et al. Ethical thinking on the number of embryos transferred for women with advanced age [J]. Chinese Journal of Reproduction and Contraception, 2020, 40(7): 610-613.
[20] Namath A, Jahandideh S, Devine K, et al. Gestational carrier pregnancy outcomes from frozen embryo transfer depending on the number of embryos transferred and preimplantation genetic testing: a retrospective analysis [J]. Fertil Steril, 2021, 115(6): 1471-1477.
[21] Bai F, Wang DY, Fan YJ, et al. Assisted reproductive technology service availability, efficacy and safety in mainland China: 2016 [J]. Hum Reprod, 2020, 35(2): 446-452.
[22] 赵君利, 袁莹莹. 辅助生殖治疗中多胎妊娠的防治[J]. 山东大学学报(医学版), 2019, 57(10): 20-26. ZHAO Junli, YUAN Yingying. Prevention and treatment of multiple pregnancy in assisted reproductive therapy [J]. Journal of Shandong University(Health Sciences), 2019, 57(10): 20-26.
[23] 石玉华, 蒋琪. 辅助生殖治疗中卵巢过度刺激综合征的防治[J]. 山东大学学报(医学版), 2019, 57(10): 13-19. SHI Yuhua, JIANG Qi. Prevention and treatment of ovarian hyperstimulation syndrome in assisted reproductive therapy [J]. Journal of Shandong University(Health Sciences), 2019, 57(10): 13-19.
[24] 李松, 徐艳文. 未破裂卵泡黄素化综合征的高危因素和临床处理[J]. 中国实用妇科与产科杂志, 2021, 37(4): 431-435. LI Song, XU Yanwen. High- risk factors and clinical treatment of luteinized unruptured follicle syndrome [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2021, 37(4): 431-435.
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