微刺激中高黄体生成素水平对于IVF结局影响病例对照研究

发布时间：2018-04-11 01:24

本文选题：血清黄体生成素 + 微刺激　；参考：《上海交通大学》2014年硕士论文

【摘要】：目的：采用病例对照研究方法，探讨在全胚冷冻移植的前提下，微刺激促排卵过程发生高血清黄体生成素水平对于不孕症患者IVF结局的影响。方法：采用病例对照研究方法，回顾性分析2012年10月至2013年10月间在上海交通大学医学院附属第九人民医院辅助生殖科接受IVF/ICSI治疗患者共180例，观察在微刺激促排期间出现高血黄体生成素水平病例90例，对照组按年龄、不孕年限、不孕原因、周期用药方案等因素与病例组严格1：1配对，从接受IVF/ICSI治疗的患者中随机抽取。根据卵巢储备功能及不孕症背景差异，分为卵巢功能正常组、多囊卵巢组，卵巢隐性衰竭组三组，将各组病例组与对照组获卵数、受精率、卵裂率、有效胚胎率等胚胎实验室结局进行对比分析。以全胚冷冻及冻融胚胎移植策略为前提，对于病例组与对照组的胚胎种植率，生化妊娠率及临床妊娠率进行对比分析。结果:纳入研究人群中，病例组与对照组在年龄（36.0±5.9岁 vs. 36.1±5.4岁）、不孕年限（4.90±4.30年 vs. 4.87±3.98年）、既往无可用胚胎周期数（2.41±2.65 vs. 2.17±2.16）及既往移植失败次数（1.10±1.64 vs. 1.06±1.84），均无统计学差异（P0.05）。卵巢功能正常组中，病例组患者在促排卵期间LH水平12.81±3.07 mIU/mL明显高于对照组5.60±4.88 mIU/mL，P0.05,而病例组促排期间孕酮值（0.26±0.15 ng/mL vs. 0.25±0.10 ng/mL）、平均获卵数（2.70±1.67枚 vs. 3.0±1.85枚）、受精率（74.2% vs. 73.9%）、成熟卵率（98.39% vs. 97.1%）、卵裂率（97.8% vs. 98.0%）及优胚率（97.8% vs. 98.0%），无明显统计学差异（P0.05）。在冻融胚胎移植条件下，病例组卵巢能正常患者对照组在生化妊娠率（64.2% vs. 64.7%）、种植率（36.8% vs. 40.7%）、临床妊娠率（50% vs. 52.9%）与对照组均无显著差异（P0.05）。多囊卵巢组中，病例组在平均获卵（6.86±3.35枚 vs. 6.67±3.40枚）、成熟卵率（90.7% vs. 87.6%）、卵裂率（97.1% vs. 96.3%）、优质胚胎率（63.6% vs. 68.3%），均无统计学差异（P0.05）。两组在移植解冻胚胎后生化妊娠率（61.5% vs. 61.9%）及临床妊娠率（53.8% vs. 57.1%），无明显统计学差别。卵巢隐性衰竭组中，病例组与对照组在受精率（97.91% vs. 94.29%），卵裂率（42.47% vs. 49.31%），，均无统计学差异（P0.05）。在优质胚胎数上，病例组平均1.29±0.49枚与对照组1.24±0.53枚相比无统计学差异（P0.05）。在冷冻胚胎移植结局，卵巢隐性衰竭患者病例组与对照组在种植率（36.8% vs. 33.3%），无统计学差异（P0.05）。而病例组在生化妊娠率（46.7% vs. 40.0%），临床妊娠率（40% vs. 35%）高于对照组，具有显著统计学差异，P0.05，可能与两组移植病例数较少有关。结论：本研究观察到微刺激促排卵过程中高血LH水平对于患者IVF/ICSI结局并无显著影响，提示高LH状态下依然可以获得具有成熟的卵母细胞和具有发育潜力的胚胎，通过移植获得妊娠。
[Abstract]:Objective: to investigate the effect of high serum luteinizing hormone (LPO) level on the outcome of IVF in infertile patients with microstimulation and ovulation stimulation under the premise of whole embryo cryopreservation.Methods: from October 2012 to October 2013, 180 IVF/ICSI patients were treated with IVF/ICSI in the Department of Auxiliary Reproduction of the Ninth affiliated people's Hospital, Shanghai Jiaotong University Medical College, from October 2012 to October 2013, using a case-control study.90 cases with high luteinizing hormone level were observed during microstimulation. The control group was matched with the patient group at 1:1 strictly according to age, length of infertility, cause of infertility, and periodic medication regimen, and was randomly selected from the patients receiving IVF/ICSI treatment.According to the difference of ovarian reserve function and infertility background, the patients were divided into three groups: normal ovarian function group, polycystic ovary group and recessive ovarian failure group.The effective embryo rate and other embryo laboratory outcomes were compared and analyzed.The embryo implantation rate, biochemical pregnancy rate and clinical pregnancy rate of the case group and the control group were compared and analyzed on the premise of the whole embryo freezing and freeze-thawing embryo transfer strategy.In the normal ovarian function group,Under the condition of frozen-thawed embryo transfer, there was no significant difference in biochemical pregnancy rate (64.2% vs .64.7%), implantation rate (36.8% vs .40.7%) and clinical pregnancy rate (50% vs .52.9%) between the control group and the control group.In the polycystic ovary group, the average number of oocytes was 6.86 卤3.35 vs 6.67 卤3.40, the maturation rate was 90.7% vs 87.6%, the cleavage rate was 97.1% vs 96.3cm, and the high quality embryo rate was 63.6% vs 68.30.There was no significant difference between the two groups (P 0.05).The biochemical pregnancy rate (61.5% vs. 61.9%) and the clinical pregnancy rate (53.8% vs. 57.1%) were not significantly different between the two groups.In the recessive ovarian failure group, the fertilization rate was 97.91% vs 94.29%, the cleavage rate was 42.47% vs 49.31%, there was no significant difference between the two groups (P 0.05).There was no significant difference in the number of high quality embryos between the case group and the control group (1.29 卤0.49 vs 1.24 卤0.53).In the outcome of cryopreservation embryo transfer, the implantation rate of patients with recessive ovarian failure was 36.8% vs 33.30.There was no significant difference between the two groups (P 0.05).The biochemical pregnancy rate of 46.7% vs. 40.0% and the clinical pregnancy rate of 40% vs. 35) in the case group were significantly higher than those in the control group (P 0.05), which may be related to the small number of transplant cases in the two groups.Conclusion: in this study, it was observed that high blood LH level had no significant effect on the outcome of IVF/ICSI in patients with ovulation induced by microstimulation, suggesting that mature oocytes and embryos with developmental potential could still be obtained under the condition of high LH.Pregnancy is obtained by transplantation.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

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