Objective: To compare the clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET) among patients in different conditions receiving luteinizing hormone supplementation in GnRH-agonist long protocol.
Methods: Between June, 2010 and December, 2015, 671 IVF-ET cycles with GnRH-agonist long protocol were performed at our center. These cycles were divided into group A with FSH only and group B with FSH and recombinant luteinizing hormone (r-LH) supplementation, and each group was divided into 4 subgroups according to age (<35 or ≥35) and the LH level on the initial day (<1.0 U/L or ≥1.0 U/L). The effects of LH supplementation on the clinical pregnancy rate and implantation rate were compared among different subgroups.
Results: No statistical significances were found between groups A and B in age, body mass index (BMI), basal FSH, basal LH, basal E2, Gn dosage, Gn day, LH on HCG day, E2 on HCG day, P on HCG day, number of oocytes, fertilization rate, available embryo rate or good quality embryo rate per oocyte, but the endometrium thickness on HCG day differed significantly between the two groups. In women below 35 years of age with a LH level on HCG day over 1.0 U/L, r-LH supplementation resulted in a clinical pregnancy rate of 60%, significantly lower than the rate of 79.55% in women without r-LH supplementation (P<0.05). In women over 35 years with a LH level below 1.0 U/L, r-LH supplementation resulted in an implantation rate of 44.74%, as compared with 24.74% in women without r-LH supplementation (P<0.05).
Conclusion: In the long protocol, LH supplementation does not improve the oocyte number, fertilization rate, or good quality embryo per oocyte, and does not bring benefits to women below 35 years with a low LH level (<1.0 U/L) or those over 35 years with normal LH level (≥1.0 U/L) after GnRH-agonist administration. But for women over 35 years with low LH levels, r-LH supplementation may improve the clinical pregnancy rate and implantation rate of IVF-ET cycles.
目的: 比较在不同人群中添加黄体生成素在长方案超排卵过程中的临床结局。
方法: 选择2010年6月~2015年12月在广州市妇女儿童医疗中心生殖医学中心进行体外受精-胚胎移植助孕的671个周期，均使用自然周期黄体期长方案促排卵，按促排卵从启动日是否添加重组黄体生成素（r-LH）分为A组（单用卵泡刺激素FSH）和B组（FSH+r-LH），再根据年龄是否小于35岁和启动日LH是否小于1.0 U/L分成4个亚组，分别比较不同亚组中是否添加LH对临床妊娠率和种植率的影响。
结果: 两组患者在年龄、体质量指数、基础FSH、基础LH、基础雌二醇（E2）、促性腺激素剂量及天数、扳机日LH、扳机日E2、扳机日孕酮、获卵数、受精率、每卵子可用胚胎率及优胚率上均相似，差异无统计学意义，仅在扳机日内膜厚度上差异有统计学意义；亚组分析显示：对于年龄＜35岁且启动日LH＜1.0 U/L及年龄≥35岁且启动日LH≥1.0 U/L的患者，单用FSH组和FSH+r-LH组在临床妊娠率和种植率上均相似，差异无统计学意义；对于年龄＜35岁且启动日LH≥1.0 U/L的患者，FSH+r-LH组临床妊娠率60%，低于单用FSH组的临床妊娠率79.55%，差异有统计学意义（P＜0.05）；对于年龄≥35岁且启动日LH＜1.0 IU/L的患者，FSH+r-LH组的种植率为44.74%，高于单用FSH组的种植率24.74%，差异有统计学意义（P＜0.05）。
结论: 在长方案中，与单用FSH相比，添加LH并不提高获卵数、受精率及每卵子优质胚胎率；对年龄＜35岁即使降调节后LH水平低或年龄≥35岁但降调后LH≥1.0 U/L者添加LH并不能使患者明显获益，对于年龄≥35岁且降调后LH＜1.0 U/L的患者添加LH可能改善临床妊娠率和种植率，而对于年龄＜35岁且启动日≥LH1.0 U/L的患者应慎重选择添加外源性LH。