卵泡液中FSH、LH水平与不孕患者助孕结局关系的探究
发布时间：2019-04-25 08:32
【摘要】：背景和目的:卵泡液是卵母细胞赖以生存的微环境,卵泡液除含有普通的营养成分以外,还有卵泡细胞分泌的类固醇激素及多种生物活性物质,对卵泡的发育、卵母细胞的成熟有重要影响,为辅助生殖技术(assisted reproductive technology,ART)中获得良好的助孕结局提供前提条件。卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteal hormone,LH)是由腺垂体分泌的两个具有协同作用的促性腺激素,具有刺激颗粒细胞增生、促进甾体激素分泌的作用,是促进卵泡发育、成熟的重要成分。目前大部分研究仅观察基础外周血FSH、LH水平与卵巢储备的关系及利用基础外周血FSH、LH预测促排卵结局的作用,而卵泡成熟期靶器官中FSH、LH水平及其与辅助生殖助孕结局的关系还有待深入研究。本实验主要研究不孕患者取卵日卵泡液中FSH和LH水平与体外受精/卵胞质内单精子显微注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)结局的关系。方法:选择2016年3~5月在南昌大学辅助生殖中心接受常规长方案IVF/ICSI-ET治疗的111例不孕患者作为研究对象,收集患者取卵日卵泡液,采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测其中FSH和LH的水平。1.将患者卵泡液中FSH、LH水平与患者基本情况、基础性激素水平、HCG日血清激素水平、用药情况及获卵数做相关分析;2.将接受新鲜胚胎移植的患者按是否获得临床妊娠分为两组:妊娠组与未妊娠组。并将患者基本情况、基础性激素水平、HCG日血清激素水平、用药情况、患者获得的实验室结局及卵泡液中FSH、LH水平做两组间比较;3.将所有样本按卵泡液FSH水平分为FSH㩳3.0IU/L组(A组)、FSH3.0~7.5 IU/L组(B组)、FSH㧐7.5 IU/L组(C组)。分析患者基本情况、获卵数、受精率、优质胚胎率、多PN受精率、移植率、临床妊娠率在三组间比较是否存在差异。结果:1.卵泡液中FSH水平与患者每个有效卵泡Gn用量呈正相关,与HCG日血E2值及获卵数呈负相关(P㩳0.01);卵泡液中LH水平与患者每个有效卵泡Gn用量及HCG日血LH值呈正相关,与获卵数呈负相关(P㩳0.05),但相关性均较弱。2.妊娠组与未妊娠组之间受精率、优质胚胎率及卵泡液FSH水平存在显著差异(P㩳0.01),而其他指标两组间无统计学差异(P㧐0.05)。3.卵泡液FSH水平不同的三组中,B组优质胚胎率、妊娠率均显著高于A组、C组(P㩳0.05)。B组受精率也高于C组,差异有统计学意义(P㩳0.05)。结论:卵泡液FSH水平与IVF/ICSI-ET结局相关,浓度在3.0~7.5 IU/L时IVF/ICSI-ET结局最佳。由于本实验中患者卵泡液LH水平均处于较低水平,尚不能对卵泡液中LH水平与助孕结局的关系作出评价。
[Abstract]:Background and objective: follicular fluid is the microenvironment for oocytes to survive. Follicular fluid not only contains common nutritional components, but also contains steroid hormones secreted by follicular cells and various bioactive substances to the development of follicles. The maturation of oocytes plays an important role, which provides a prerequisite for obtaining a good outcome of assisted pregnancy in assisted reproductive technology (assisted reproductive technology,ART). Follicle-stimulating hormone (follicle-stimulating hormone,FSH) and luteinizing hormone (luteal hormone,LH) are two synergetic gonadotropins secreted by adenohypophysis, which can stimulate the proliferation of granulosa cells and promote the secretion of steroids. It is an important component to promote follicular development and maturation. At present, most studies have only observed the relationship between basal peripheral blood FSH,LH level and ovarian reserve and the role of basal peripheral blood FSH,LH in predicting the outcome of ovulation induction, while FSH, in target organs during follicular maturation is only observed. The relationship between LH level and assisted reproductive outcomes remains to be further studied. The purpose of this study was to investigate the relationship between the levels of FSH and LH in follicular fluid of infertile patients and the outcome of in vitro fertilization / intracytoplasmic sperm microinjection-embryo transfer (in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET). Methods: from March to May 2016, 111 infertile patients who received routine long-term IVF/ICSI-ET therapy in the Auxiliary Reproductive Center of Nanchang University were selected as subjects. Follicular fluid was collected from the patients, and enzyme-linked immunosorbent assay (enzyme linked immunosorbent assay,) was used to detect the follicular fluid. ELISA) in which the levels of FSH and LH were detected. The level of FSH,LH in follicular fluid of the patients was correlated with the basic condition, basic hormone level, serum hormone level on the day of HCG, drug use and the number of eggs obtained. 2. The patients who received fresh embryo transfer were divided into two groups according to whether they got clinical pregnancy or not: pregnant group and non-pregnant group. The basic condition, basic hormone level, serum hormone level on day of HCG, drug use, laboratory outcome and FSH,LH level in follicular fluid were compared between the two groups. All samples were divided into FSH?3.0IU/L group (group A), FSH3.0~7.5 IU/L group (group B) and FSH?7.5 IU/L group (group C) according to the level of FSH in follicular fluid. The patients' basic condition, number of eggs, fertilization rate, high quality embryo rate, multiple PN fertilization rate, transplantation rate and clinical pregnancy rate were compared among the three groups. Results: 1. The level of FSH in follicular fluid was positively correlated with the dosage of Gn in each effective follicle of the patient, and negatively correlated with the E _ 2 value of blood and the number of eggs obtained on the day of HCG (P0. 01). The level of LH in follicular fluid was positively correlated with the dosage of Gn in each effective follicle and the value of LH in blood on the day of HCG, but negatively correlated with the number of oocytes obtained (P0. 05), but the correlation was weak. There were significant differences in fertilization rate, quality embryo rate and follicular fluid FSH level between pregnant group and non-pregnant group (P0. 01), but there was no significant difference in other indexes between the two groups (P < 0. 05). Among the three groups with different levels of FSH in follicular fluid, the rate of high quality embryo and pregnancy in group B was significantly higher than that in group A, and the fertilization rate in group C (P0. 05). B group) was also higher than that in group C (P < 0. 05). Conclusion: the level of FSH in follicular fluid is correlated with the outcome of IVF/ICSI-ET, and the best outcome of IVF/ICSI-ET is at the concentration of 3.0 IU/L 7.5 IU/L. Because of the low level of LH in follicular fluid, the relationship between the level of LH in follicular fluid and the outcome of assisted pregnancy can not be evaluated.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8
本文编号：2464942
[Abstract]:Background and objective: follicular fluid is the microenvironment for oocytes to survive. Follicular fluid not only contains common nutritional components, but also contains steroid hormones secreted by follicular cells and various bioactive substances to the development of follicles. The maturation of oocytes plays an important role, which provides a prerequisite for obtaining a good outcome of assisted pregnancy in assisted reproductive technology (assisted reproductive technology,ART). Follicle-stimulating hormone (follicle-stimulating hormone,FSH) and luteinizing hormone (luteal hormone,LH) are two synergetic gonadotropins secreted by adenohypophysis, which can stimulate the proliferation of granulosa cells and promote the secretion of steroids. It is an important component to promote follicular development and maturation. At present, most studies have only observed the relationship between basal peripheral blood FSH,LH level and ovarian reserve and the role of basal peripheral blood FSH,LH in predicting the outcome of ovulation induction, while FSH, in target organs during follicular maturation is only observed. The relationship between LH level and assisted reproductive outcomes remains to be further studied. The purpose of this study was to investigate the relationship between the levels of FSH and LH in follicular fluid of infertile patients and the outcome of in vitro fertilization / intracytoplasmic sperm microinjection-embryo transfer (in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET). Methods: from March to May 2016, 111 infertile patients who received routine long-term IVF/ICSI-ET therapy in the Auxiliary Reproductive Center of Nanchang University were selected as subjects. Follicular fluid was collected from the patients, and enzyme-linked immunosorbent assay (enzyme linked immunosorbent assay,) was used to detect the follicular fluid. ELISA) in which the levels of FSH and LH were detected. The level of FSH,LH in follicular fluid of the patients was correlated with the basic condition, basic hormone level, serum hormone level on the day of HCG, drug use and the number of eggs obtained. 2. The patients who received fresh embryo transfer were divided into two groups according to whether they got clinical pregnancy or not: pregnant group and non-pregnant group. The basic condition, basic hormone level, serum hormone level on day of HCG, drug use, laboratory outcome and FSH,LH level in follicular fluid were compared between the two groups. All samples were divided into FSH?3.0IU/L group (group A), FSH3.0~7.5 IU/L group (group B) and FSH?7.5 IU/L group (group C) according to the level of FSH in follicular fluid. The patients' basic condition, number of eggs, fertilization rate, high quality embryo rate, multiple PN fertilization rate, transplantation rate and clinical pregnancy rate were compared among the three groups. Results: 1. The level of FSH in follicular fluid was positively correlated with the dosage of Gn in each effective follicle of the patient, and negatively correlated with the E _ 2 value of blood and the number of eggs obtained on the day of HCG (P0. 01). The level of LH in follicular fluid was positively correlated with the dosage of Gn in each effective follicle and the value of LH in blood on the day of HCG, but negatively correlated with the number of oocytes obtained (P0. 05), but the correlation was weak. There were significant differences in fertilization rate, quality embryo rate and follicular fluid FSH level between pregnant group and non-pregnant group (P0. 01), but there was no significant difference in other indexes between the two groups (P < 0. 05). Among the three groups with different levels of FSH in follicular fluid, the rate of high quality embryo and pregnancy in group B was significantly higher than that in group A, and the fertilization rate in group C (P0. 05). B group) was also higher than that in group C (P < 0. 05). Conclusion: the level of FSH in follicular fluid is correlated with the outcome of IVF/ICSI-ET, and the best outcome of IVF/ICSI-ET is at the concentration of 3.0 IU/L 7.5 IU/L. Because of the low level of LH in follicular fluid, the relationship between the level of LH in follicular fluid and the outcome of assisted pregnancy can not be evaluated.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8
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