体外受精-胚胎移植（IVF-ET）促排卵方案对HCG日孕酮水平及其临床结局的影响

发布时间：2018-03-23 03:02

  本文选题：体外受精(IVF)　切入点：重组人卵泡刺激素(rFSH)　出处：《南京医科大学》2017年博士论文　论文类型：学位论文

【摘要】：IVF促排卵晚卵泡期孕酮升高比较常见,有证据显示过早孕酮升高对辅助生殖技术的结果会产生不利影响,高于某一阈值可以观察到IVF新鲜周期中持续妊娠率的下降。卵巢刺激中过早孕酮水平升高的原因尚不完全清楚,研究指出大量FSH刺激是孕酮水平升高的一个原因,HCG和LH活性可能有保护作用,防止可能的过早孕酮升高,这一假设尚存在一些争议。研究目的:研究体外受精-胚胎移植(IVF-ET)长方案中添加LH活性对IVF-ET晚卵泡期孕酮水平的影响,以及孕酮水平对临床结局的不利影响。研究方法:第一部分,回顾性分析南京医科大学第一附属医院生殖中心六年间IVF-ET采用长方案及拮抗剂方案进行卵巢刺激的11065例患者,统计HCG日孕酮水平升高的发生率。其中鲜胚移植的6986例新鲜周期移植患者按HCG日孕酮阈值8nmol/L分为甲组(HCG日孕酮8nmol/L)和乙组(HCG日孕酮≥8nmol/L),比较孕酮水平增高对临床结局的不利影响。第二部分,一项纳入六个国家批准的具有IVF资质的临床生殖中心中行IVF长方案治疗助孕的610患者的前瞻性,多中心,随机对照临床试验,受试者随机分为2组:A组接受HP-HMG加rFSH(n=305)促排卵,而B组单独接受rFSH(n = 305)促排卵,比较人绒毛膜促性腺激素(HCG)给药当天的孕酮水平及其临床结局。研究结果:第一部分:长方案及拮抗剂方案间孕酮升高的的发生率无统计学差异;年轻患者(≤35岁)与年龄大患者相比(35岁),HCG日孕酮升高的发生率高。乙组(HCG日孕酮≥8nmol/L)HCG日雌二醇水平、Gn总剂量、获卵数、受精率、可移植卵裂期胚胎数均明显高于甲组(HCG日孕酮8nmol/L),而临床妊娠率、种植率、双胎率、活产率均明显低于甲组。第二部分:两组人群基线无统计学意义差异。HCG给药当天孕酮(P)水平B组(4.3±2.2nmol/1)明显高于A组(3.8±1.7nmol/1)(P0.05)。获得卵母细胞数B组(12.9±5.6)明显高于A组(11.9±6.0)(P0.05)。受精率B组(69.2%)明显低于A组(73.9%)(P0.05)。然而,两组之间的卵裂率,种植率,临床妊娠率和卵巢过度刺激(OHSS)率无统计学意义差异,但为预防OHSS的鲜胚移植取消率A组(34.8%)明显(P0.05)低于B组(43.2%)。结论:第一部分:HCG日孕酮水平升高会对IVF的妊娠结局会产生不利影响,由于孕酮升高对卵母细胞或胚胎的质量没有影响,可以推测卵巢刺激期间孕酮水平升高改变子宫内膜容受性,是妊娠率降低的原因。第二部分:在接受IVF-ET GnRHa长方案的妇女中,与单独使用rFSH相比,使用HP-HMG加rFSH促排卵hCG当天平均孕酮水平明显降低,获卵母细胞数明显降低,受精率明显升高,为预防OHSS的鲜胚移植取消率明显下降,但其他临床结局指标两组之间没有差异。临床试验注册号:ChiCTR-TRC-14004552。(中国临床试验注册机构,2014年4月21日)
[Abstract]:The increase of progesterone in late follicular phase of ovulation induced by IVF is more common, and there is evidence that premature progesterone increase has a negative effect on the outcome of assisted reproductive technology. A decrease in the rate of persistent pregnancy during the fresh cycle of IVF can be observed above a certain threshold. The reason for the rise of prematurely progesterone levels in ovarian stimulation is not entirely clear. It has been suggested that a large number of FSH stimuli may be a cause of increased progesterone levels, and that the activities of HCG and LH may have a protective effect against possible premature progesterone elevation. This hypothesis remains controversial. Objective: to study the effect of LH activity on progesterone levels in late follicular phase of IVF-ET. Methods: the first part was to retrospectively analyze 11065 IVF-ET patients who used long regimen and antagonist regimen for ovarian stimulation in the reproductive center of the first affiliated Hospital of Nanjing Medical University during the past six years. According to the HCG daily progesterone threshold value, 6986 fresh embryo transplant patients were divided into two groups: group A (group A) and group B (day progesterone 鈮，

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