■卵巢对促性腺激素刺激的反应性各不相同,和单独调整促性腺激素释放激素(GnRH-A)拮抗剂给药的时间和剂量是必要的,以防止GnRH拮抗剂(GnRH-A)方案后具有不同卵巢反应的患者黄体生成素(LH)水平的过度升高和降低。本研究旨在探讨卵巢反应正常(NOR)患者的最佳LH抑制阈值。卵巢高反应(HOR),和GnRH-A方案后卵巢反应差(POR)。
■包括使用灵活或固定的GnRH-A方案的总共865个体外受精(IVF)周期。患者被归类为HOR,NOR,或POR组根据他们的抗苗勒管激素(AMH)水平。然后,根据触发日基础LH水平与LH比值(bLH/hLH)的四分位数(Q1-Q4),将每组患者分为4个亚组之一.主要结果是临床妊娠率和活产率,次要结果是检索到的卵母细胞数量,MII卵母细胞,两个原核(2PN)胚胎,和高质量的胚胎。
■有526名NOR患者,180与HOR,和159与POR。基础LH水平,通过Logistic回归分析确定触发日LH和bLH/hLH是临床妊娠率和活产率的独立预测因子。与NOR相比,POR患者的胚胎植入率最低(22.6%vs.32.8%,P<0.05),临床妊娠率(32.3%vs.47.3%,P<0.05)和活产率(22.6vs.37.8%,P<0.05)新鲜胚胎移植(ET)。胚胎植入,冷冻胚胎移植(FET)的临床妊娠率和活产率在三组之间没有显着差异。在亚组分析中,HOR患者的胚胎植入率最高(51.6%,P<0.05),临床妊娠率(68.4%,P<0.05)和活产率(52.6%,Q3中ET的P<0.05),bLH/hLH比值为2.40-3.69。在NOR组中,胚胎着床率(41.9%,P<0.05),临床妊娠率(61.5%,P<0.05)和活产率(50.8%,P<0.05)ET和活产率(53.1%,FET的P<0.05)在Q2中最高,bLH/hLH比率为1.29-2.05。POR患者的临床妊娠率最高(57.1%,P<0.05)和活产率(42.9%,Q2中ET的P<0.05),bLH/hLH比值为0.86-1.35。
■在本研究中,bLH/hLH比值代表LH抑制阈值。HOR的亚组分析,NOR和POR显示,LH抑制阈值因卵巢反应而异.对于HOR,我们建议LH抑制阈值为2.40-3.69,1.29-2.05对于NOR,而POR为0.86-1.35则获得最高的临床妊娠率和活产率。这项研究为临床医生根据GnRH-A方案后患者的卵巢反应在控制性卵巢刺激(COS)期间单独监测LH水平提供了全面而准确的参考。
UNASSIGNED: Ovarian reactivity to gonadotrophin stimulation varies, and individual adjustments to the timing and dose of gonadotrophin-releasing hormone (GnRH) antagonist administration are necessary to prevent excessive increases and decreases in luteinizing hormone (LH) levels in patients with different ovarian response following the GnRH antagonist (GnRH-A) protocol. The present study aims to investigate optimal LH suppression thresholds for patients with normal ovarian response (NOR), high ovarian response (HOR), and poor ovarian response (POR) following the GnRH-A protocol respectively.
UNASSIGNED: A total of 865 in vitro fertilization (IVF) cycles using a flexible or fixed GnRH-A protocol were included. Patients were categorized into the HOR, NOR, or POR group according to their anti-Müllerian hormone (AMH) levels. Then, patients in each group were stratified into one of four subgroups according to the quartile (Q1-Q4) of the basal LH level to LH on triggering day ratio (bLH/hLH). The primary outcomes were the clinical pregnancy and live birth rates, and the secondary outcomes were the number of oocytes retrieved, MII oocytes, two pronucleus (2PN) embryos, and good-quality embryos.
UNASSIGNED: There were 526 patients with NOR, 180 with HOR, and 159 with POR. Basal LH level, LH on triggering day and bLH/hLH were identified as independent predictors of clinical pregnancy rate and live birth rate by logistics regression analysis. Compared to those with NOR, patients with POR had the lowest embryo implantation rate (22.6% vs. 32.8%, P < 0.05), clinical pregnancy rate (32.3% vs. 47.3%, P < 0.05) and live birth rate (22.6 vs. 37.8%, P < 0.05) of fresh embryo transfer (ET). The embryo implantation, clinical pregnancy and live birth rates of frozen embryo transfer (FET) were not significantly different among the three groups. In the subgroup analysis, patients with HOR had the highest embryo implantation rate (51.6%, P < 0.05), clinical pregnancy rate (68.4%, P < 0.05) and live birth rate (52.6%, P < 0.05) of ET in Q3, with a bLH/hLH ratio of 2.40-3.69. In the NOR group, the embryo implantation rate (41.9%, P < 0.05), clinical pregnancy rate (61.5%, P < 0.05) and live birth rate (50.8%, P < 0.05) of ET and live birth rate (53.1%, P < 0.05) of FET were highest in Q2, with a bLH/hLH ratio of 1.29-2.05. Patients with POR had the highest clinical pregnancy rate (57.1%, P < 0.05) and live birth rate (42.9%, P < 0.05) of ET in Q2, with a bLH/hLH ratio of 0.86-1.35.
UNASSIGNED: In the present study, the bLH/hLH ratio represented the LH suppression threshold. The subgroup analysis of HOR, NOR and POR showed that, the LH suppression threshold varies according to ovarian response. We recommend LH suppression thresholds of 2.40-3.69 for HOR, 1.29-2.05 for NOR, and 0.86-1.35 for POR to obtain the highest clinical pregnancy rate and live birth rate. This study provides comprehensive and precise references for clinicians to monitor LH levels individually during controlled ovarian stimulation (COS) according to the patient\'s ovarian response following the GnRH-A protocol.