尿促性素不同作用时相对体外受精-胚胎移植结局的影响

目的 探讨体外受精-胚胎移植控制性超促排卵长方案(长方案),在卵泡发育的不同时期添加尿促性素(HMG)对体外受精-胚胎移植(IVF-ET)结局的影响.方法 回顾性分析了采用长方案行IVF-ET,卵巢储备功能正常,垂体降调后启动日血清黄体生成激素(LH)水平较低(＜1 U/L)患者145例,依据HMG添加的时机不同分为:早卵泡期组(组1,43例)、中卵泡期组(组2,46例)、晚卵泡期组(组3,56例),分析比较3组妊娠结局.结果 3组降调时间、促性腺激素(Gn)天数、获卵数、注射绒毛膜促性腺激素(hCG)日雌二醇(E2)、启动日及中期LH比较差异均无统计学意义(P均＞0.05)；Gn总量比较差异有统计学意义(F=10.071,P＜0.001),其中组3 Gn总量(2225±292)U]低于组1(2624±422)U]和组2(2472±417)U](P均＜0.05)；注射hCG日LH比较差异有统计学意义(F =4.184,P=0.018),其中组1注射hCG日LH(0.46±0.37)U/L]低于组2(0.72±0.58)U/L](P ＜0.05)；可用胚胎率比较差异有统计学意义(x2=8.965,P=0.011),其中组3可用胚胎率62.5％(288/461)]高于组155.0％(170/309)]和组252.8％(208/394)](P均＜0.05)；受精率、卵裂率、优胚率、着床率、临床妊娠率、流产率3组比较差异均无统计学意义(P均＞0.05),其中组3的优胚率、临床妊娠率、胚胎种植率高于组1、组2,而组1的流产高于组2、组3.结论 对于长方案垂体降调节后LH过度抑制的卵巢储备功能正常患者,于卵泡晚期添加HMG有助于提高优胚率、可用胚胎率、着床率、临床妊娠率,降低流产率.

The influence of time-course HMG administration upon the outcome of in vitro fertilization-embryo transfer

Objective To investigate the influence of human menopausal gonadotropin(HMG)administration at different phase of follicular development upon the outcome of in vitro fertilization-embryo transfer(IVF-ET)in the long-program.Methods A retrospective analysis was performed in 145 patients underwent the long program IVF-ET,who were normal in ovarian reservation but with low levels of serum leteinizing hormone(LH)(＜ 1 U/L)after the pituitary down-regulation.According to the time point of HMG administration,the patients were classified into three groups:early follicular phase(group 1,43 patients),midfollicular phase(group 2,46 patients)and late follicular phase(group 3,56 patients).The outcomes of these three groups were compared.Results Between the three groups,there was no difference in the down-regulation time,days receiving gonadotropin(Gn),the number of oocytes retrieved,day of estradiol(E2)on the day receiving chorionic gonadotrophin(hCG)injection,start date and interim LH,fertilization rate and cleavage rate (all P ＞ 0.05).In group 3,the total Gn dosage(2225 ± 292]U)was lower than that of group 1(2624 ± 422]U)(P ＜ 0.05)and group 2(2472 ± 417]U)(P ＜ 0.05).In group 1,the LH level on the day receiving hCG(0.46 ± 0.37)U/L]was lower than that in group 2(0.72 ± 0.58)U/L](P＜0.05).The rate of usable embryos in group 362.5％(288/461)]was higher than that of group 155.0％(170/309)]and group 252.8％(208/394)](P =0.011).Though the high qualified embryo rate,clinical pregnancy rate and implantation rate in group 3 were higher than that in goup 1 and group 2,and the abortion rate in group 1 was higher than that of group 2 and group 3,the difference was not significant(P ＞ 0.05).Conclusion For the patients with over-suppressed LH in the long-program pituitary down-regulation but with normal ovarian reservation,additional HMG during late follicular phase is helpful to improve the high qualified emryo rate,excellent rates of embryos,embryos availability,implantation rate and clinical pregnancy rate,and lower the abortion rate.