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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
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