CAJ | 학술논문

目的评价重组人黄体生成素(r-hLH)在体外受精-胚胎移植(IVF-ET)促排卵治疗中的应用及其对妊娠结局的影响.方法回顾性分析2009年4-7月在山东大学附属省立医院生殖医学中心进行IVF-ET治疗、垂体降调节后月经第3天血清黄体生成素(LH)水平较低(<1 U/L)的患者,其中给予r-hLH补充治疗的66例患者为r-hLH组,未给予r-hLH补充治疗的57例患者为非r-hLH组;另选择同期行IVF-ET治疗、垂体降调节后月经第3天血清LH水平正常(1～2 U/L)且未给予r-hLH补充治疗的145例患者为对照组.比较3组患者的促性腺激素(Gn)总量、注射人绒毛膜促性腺激素(hCG)日血清雌二醇及LH水平、获卵数、双原核胚胎率、优质胚胎率、着床率及临床妊娠率等.结果 r-hLH组、非r-hLH组及对照组患者注射hCG日的LH水平分别为(1.59±0.77)、(0.54±0.25)及(2.39±1.01)U/L,分别比较,差异均有统计学意义(P<0.05);优质胚胎率分别为59.36%、57.79%和65.94%,r-hLH组及非r-hLH组均低于对照组,差异均有统计学意义(P<0.05);双原核胚胎率分别为67.62%、62.84%和68.32%,r-hLH组及对照组均高于非r-hLH组,差异均有统计学意义(P<0.05);着床率分别为29.77%、18.26%和24.47%,r-hLH组高于非r-hLH组,差异有统计学意义(P<0.05);3组患者的Gn总量、注射hCG日雌二醇水平、平均获卵数、临床妊娠率分别比较,差异均无统计学意义(P>0.05).结论对于长方案垂体降调节后LH过度抑制的患者,补充r-hLH可以获得较高的优质胚胎率、双原核胚胎率和着床率.
목적 평개중조인황체생성소(r-hLH)재체외수정-배태이식(IVF-ET)촉배란치료중적응용급기대임신결국적영향.방법 회고성분석2009년4-7월재산동대학부속성립의원생식의학중심진행IVF-ET치료、수체강조절후월경제3천혈청황체생성소(LH)수평교저(<1 U/L)적환자,기중급여r-hLH보충치료적66례환자위r-hLH조,미급여r-hLH보충치료적57례환자위비r-hLH조;령선택동기행IVF-ET치료、수체강조절후월경제3천혈청LH수평정상(1～2 U/L)차미급여r-hLH보충치료적145례환자위대조조.비교3조환자적촉성선격소(Gn)총량、주사인융모막촉성선격소(hCG)일혈청자이순급LH수평、획란수、쌍원핵배태솔、우질배태솔、착상솔급림상임신솔등.결과 r-hLH조、비r-hLH조급대조조환자주사hCG일적LH수평분별위(1.59±0.77)、(0.54±0.25)급(2.39±1.01)U/L,분별비교,차이균유통계학의의(P<0.05);우질배태솔분별위59.36%、57.79%화65.94%,r-hLH조급비r-hLH조균저우대조조,차이균유통계학의의(P<0.05);쌍원핵배태솔분별위67.62%、62.84%화68.32%,r-hLH조급대조조균고우비r-hLH조,차이균유통계학의의(P<0.05);착상솔분별위29.77%、18.26%화24.47%,r-hLH조고우비r-hLH조,차이유통계학의의(P<0.05);3조환자적Gn총량、주사hCG일자이순수평、평균획란수、림상임신솔분별비교,차이균무통계학의의(P>0.05).결론 대우장방안수체강조절후LH과도억제적환자,보충r-hLH가이획득교고적우질배태솔、쌍원핵배태솔화착상솔.
Objective To evaluate application of recombinant human luteinizing hormone (r-hLH)used in ovarian stimulation of assisted reproductive technique and impact on outcome of pregnancy. Methods From Apr. To Jul. 2009, 123 patients with low LH level ( < 1 U/L) at day 3 of menstruation and downregulation of pituitary function undergoing in vitro fertilization-embryo transfer (IVF-ET) in Reproductive Medical Center, Provincial Hospital Affiliated to Shandong University were enrolled in this study, whom were classified into 66 cases treated by r-hLH in r-hLH group and 57 cases without r-hLH treatment in non-r-hLH group. In the mean time, 145 patients with normal level of serum LH ( 1-2 U/L) not given by r-hLH treatment and undergoing IVF-ET were matched as control group. Total amount of gonadotropin, estradiol levels and LH levels on the administration of human chorionic gonadotropin ( hCG), number of oocytes retrieved, number of 2PN zygotes, rate of high quality embryos, the rates of implantation and clinical pregnancy were compared among these three groups. Results The level of serum LH on the day of hCG administration were ( 1.59 ± 0.77 ) U/L in r-hLH group, (0.54 ± 0.25 ) U/L in non-r-hLH group and (2.39 ± 1.01 ) U/L in control group, which reached tatistical difference between every two groups (P < 0.05). The rates of high quality embryo were 59.36％ in r-hLH group, 57.79％ in non-r-hLH group,which were significantly lower than 65.94％ in control group, respectively (P < 0. 05 ). The rates of 2PN were 67.62％ in r-hLH group and 68. 32％ in control group, which were significantly higher than 62. 84％ in non-r-hLH group, respectively ( P < 0.05 ). The rates of implantation of 29.77％ in r-hLH group were significantly higher than 18.26％ in non-r-hLH group ( P < 0.05 ). The total amount of gonadotropin,estradiol level on the day of hCG administration, the number of oocytes retrieved, and clinical pregnancy rate were not significantly different among those three groups ( P > 0.05 ). Conclusion The administration of recombinant human uteinizing hormone in patients who are profoundly suppressed after down-regulation with long protocol can get more quality embryos, the higher rates of 2PN and implantation.