目的:本研究的目的是探索促性腺激素释放激素拮抗剂(GnRH-A)方案中促性腺激素启动的最佳时机和黄体生成素(LH)水平的合理间隔。
方法:进行了一项回顾性队列研究,分析了1,361例实施GnRH-A方案的卵母细胞提取周期的数据。卵巢反应(包括AMH,AFC)在这些患者中被分为卵巢低反应组(窦卵泡计数[AFC]≤6,n=394),正常卵巢反应组(AFC>6和<15,n=570),和高卵巢反应组(AFC≥15,n=397),根据AFC。根据方案起始日的LH水平对患者进行分组,和临床结果(包括Gn起始剂量,Gn管理日,GnRH-ant给药天数,HCG日的P水平,HCG日的E2水平,HCG日的LH水平,移植的胚胎数量,总施肥率,胚胎着床率(%),2PN的比例,优质胚胎的比例,hCG注射日子宫内膜厚度(mm),中度至重度OHSS,亚足联在启动日,HCG注射当天A型子宫内膜的比例,临床妊娠率,生化妊娠率,早期流产率,异位妊娠率)进行比较。
结果:在GnRH-A方案启动日,在所有不同卵巢反应的患者中,LH≥5IU/L患者的体重指数(BMI)较低.LH<5IU/L组和LH≥5IU/L组的妊娠结局在不同卵巢反应组之间差异无统计学意义,但LH<5IU/L组的优质胚胎比例较高(80.3±24.9vs.74.8±26.9,P=0.035)在卵巢反应不良的患者中,LH≥5IU/L组。LH≥5IU/L组的总受精率(82.2±18.1vs85.4±15.1,P=0.021)和两个原核(2PN)的比例(69.0±20.9vs72.7±19.9,P=0.035)高于LH<5IU/L组。LH≥5IU/L组的胚胎植入率(41.4±41.3vs52.6±43.4,P=0.012)高于LH<5IU/L组。多因素Logistic分析结果显示,女性伴侣的年龄,移植的胚胎数量,优质胚胎的比例,hCG注射当天子宫内膜厚度,中重度卵巢过度刺激综合征(OHSS)是影响活产结局的独立因素(P<0.05)。
结论:GnRH-A方案中促性腺激素(Gn)起始日的LH水平不会影响妊娠结局。
OBJECTIVE: The aim of the study was to explore the optimal timing of gonadotropin initiation and the reasonable interval of luteinizing hormone (LH) levels in the gonadotropin-releasing hormone antagonist (GnRH-A) protocol.
METHODS: A retrospective cohort study was conducted to analyze the data concerning the oocyte retrieval cycles from 1,361 cases with the GnRH-A protocol implemented. The ovarian responses (including AMH, AFC) in these patients were divided into the poor ovarian response group (an antral follicle count [AFC] ≤ 6, n = 394), the normal ovarian response group (an AFC > 6 and < 15, n = 570), and the high ovarian response group (an AFC ≥ 15, n = 397), according to the AFC. The patients were sub-grouped according to LH levels on the protocol initiation day, and the clinical outcomes (including dose of Gn initiation, Gn administration days, GnRH-ant administration days, P levels on the HCG day, E2 levels on the HCG day, LH levels on the HCG day, number of embryos transferred, total fertilization rate, embryo implantation rate(%), proportion of 2PN, proportion of good-quality embryos, endometrial thickness on the hCG injection day(mm), moderate to severe OHSS, AFC on the initiation day, proportion of type A endometrium on the hCG injection day, clinical pregnancy rate, biochemical pregnancy rate, early abortion rate, ectopic pregnancy rate) were compared.
RESULTS: On the GnRH-A protocol initiation day, among all patients with different ovarian responses, the body mass index (BMI) in those with an LH ≥ 5 IU/L was lower. The differences in pregnancy outcomes between the LH < 5 IU/L group and the LH ≥ 5 IU/L group were not statistically significant across the different ovarian response groups, but the LH < 5 IU/L group had a higher proportion of good-quality embryos (80.3±24.9 vs. 74.8±26.9, P =0.035) than the LH≥5IU/Lgroup in those with poor ovarian response. The total fertilization rate (82.2±18.1 vs 85.4±15.1, P =0.021) and proportion of two pronuclei (2PN) (69.0±20.9 vs 72.7±19.9, P =0.035) were higher in the LH ≥ 5 IU/L group than the LH<5 IU/L group for those with normal ovarian responses. The embryo implantation rate (41.4±41.3 vs 52.6±43.4, P =0.012) was higher in the LH ≥ 5 IU/L group than in the LH<5 IU/L group in those with high ovarian response. The results of the multivariate logistic analysis showed that the age of the female partner, number of embryos transferred, proportion of good-quality embryos, endometrial thickness on the hCG injection day, and moderate- to-severe ovarian hyperstimulation syndrome (OHSS) were independent factors correlated with the outcome of live births (P < 0.05).
CONCLUSIONS: The LH levels on the gonadotropins (Gn) initiation day in the GnRH-A protocol will not affect pregnancy outcomes.