促性腺激素释放激素拮抗剂灵活方案中促黄体生成素一过性早升对新鲜周期IVF/ICSI-ET患者妊娠结局的影响

doi:10.13481/j.1671-587X.20220623

Abstract

Abstract:

Objective To compare the pregnant outcomes of the patients with and without transient premature of luteinizing hormone （LH） in gonadotrophin releasing hormone（GnRH） antagonist flexible protocols who underwent fresh in vitro fertilization / intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET） cycles， and to explore whether transient premature had adverse effect on the pregnancy outcomes. Methods The clinical data of 145 IVF/ICSI-ET patients who received flexible antagonist regimen to promote ovulation were analyzed retrospectively. They were divided into non-transient premature of LH group （n=105） and transient premature LH group （n=40）according to whether the patients had the transient premature of LH.The clinical indicators， laboratory indicators and clinical pregnancy outcomes of the patients were compared between two groups. Results There were no significant differences in the average age， infertility years，body mass index（BMI）， basic follicular stimulating hormone（FSH）， basic LH， basic estradiol（E₂）， anti-Mullerian hormone（AMH）， number of basic antral follicles（AFC）， percentages of the patients with poor ovarian reserve and polycystic ovarian syndrome（PCOS） patients between two groups （P>0.05）.The gonadotropin（Gn）days， LH level and E₂ level on the initial day of antagonists of the patients in transient premature of LH group were higher than those in non-transient premature of LH group （t=－3.251， P= 0.001； t=－10.198，P<0.001； t=3.233，P=0.002）， while the days of antagonist use were less than those in non-transient premature of LH group （t=3.090， P=0.003）. There were no significant differences in follicular diameter on the initial day of antagonists， E₂ and progesterone（P）levels and endometrial thickness on the trigger day， number of available oocytes， numbers（rates） of MⅡ oocytes， numbers（rates） of normal fertilization， numbers（rates） of D3 available embryos， numbers（rates） of D3 high-quality embryos， embryo implantation rates， clinical pregnancy rates and ongoing pregnancy rates of the patients between two groups （P>0.05）. The multivariate Logistic regression analysis results showed that the Gn days and E₂ level on the initial day of antagonists were the risk factors for the transient premature of LH of the patients underwent fresh IVF/ICSI-ET cycle antagonist flexible protocol［OR （95%CI）=1.516（1.128－2.038），P=0.006；OR（95%CI）=2.424（1.345－4.371），P=0.003］. Conclusion The transient premature of LH of the patients with antagonist flexible protocol during superovulation does not affect the pregnancy outcomes， but it is necessary to control the increased LH level in time and pay attention to the timing of adding antagonists.

Key words: Antagonist regimen, Luteinizing hormone, Pregnancy outcome, In vitro fertilization/intracytoplasmic sperm injection-embryo transfer

CLC Number:

R714.8

Hong GAO,Li LIN,Xiaohong YAN,Ping TAO,Youzhu LI. Effect of transient prematur of luteinizing hormone in gonadotropin releasing hormone antagonist flexible protocols on pregnancy outcomes of patients underwent fresh IVF/ICSI-ET cycles[J].Journal of Jilin University(Medicine Edition), 2022, 48(6): 1566-1573.

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References 26

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Group	n	Age (year)	Duration of infertility（year）	BMI(kg·m^－2)		AMH[ρ_B/(g·L^－1)]	Basic FSH [λ_B/(IU·L^－1)]
Non-tansient premature of LH	105	32.4±4.8	2(1,4)	21.69±2.02		2.34(1.36,3.84)	7.43±2.52
Tansient premature of LH	40	33.2±5.6	2.5(1.5,4)	22.64±3.73		2.93(1.47,5.80)	7.46±3.80
t/Z/χ²		－0.864	－0.793	－0.297		－1.163	－0.058
P		0.389	0.427	0.686		0.245	0.954
Group	n	Basic LH [λ_B/(IU·L^－1)]	Basic E₂[ρ_B/(ng·L^－1)]	No.ofAFC	Percentage of poorovary reserve(η/%)		Percentage of PCOS(η/%)
Non-tansient premature of LH	105	4.41±2.16	51.92±18.07	11.9±6.7	27（25.7）		10（9.5）
Tansient premature of LH	40	5.07±1.94	52.26±17.97	13.6±9.0	10（25）		7（17.5）
t/Z/χ²		－1.694	－0.102	－1.090	0.008		1.781
P		0.092	0.919	0.280	0.930		0.182

Group	n	Gn duration untill antagonist starting day（t/d）	E₂ level on antagonist use day E₂[ρ_B/(pg·L^－1)]	D level on antagonist use day P[ρ_B/（μg·L^－1）]	Dominant follicle diameter on antagonistuse day （l/mm）	Antagonist use duration (t/d)
Non-tansient premature of LH	105	6.62±1.39	0.92±0.57	0.64±0.42	13.83±1.75	4.42±1.53
Tansient premature of LH	40	7.49±1.34	1.40±0.86	0.75±0.44	13.98±1.63	3.78±0.92
t		－3.251	－3.233	－1.424	－0.443	3.090
P		0.001	0.002	0.157	0.658	0.003
Group	n	Gn use dosage(IU)	Gn use duration(t/d)	E₂ level on hCGinjection day [ρ_B/(pg·L^－1)]	P level on hCG injection day [ρ_B/(μg·L^－1)]	Endometrial thickness on hCG injection day（l/mm）
Non-tansient premature of LH	105	1 822.93±590.77	9.3±1.8	2.61±1.34	0.73±0.37	11.22±2.53
Tansient premature of LH	40	1 954.69±582.15	9.5±1.4	3.12±1.54	0.73±0.38	11.70±2.49
t		－1.213	－0.521	－1.972	0.120	－1.025
P		0.229	0.603	0.051	0.905	0.307

Group	n	No. of available oocytes	No. of MⅡ oocytes	No. of 2PN	No.of D3 available embryos	No.of D3 high-quality embryos
Non-tansient premature of LH	105	9.2±5.1	7.7±4.1	6.3±3.7	4.8±3.3	3.9±3.0
Tansient premature of LH	40	10.3±6.1	8.5±5.0	6.8±4.3	5.2±3.6	3.9±3.4
t/χ²		－1.086	－0.943	－0.604	－0.564	－0.020
P		0.279	0.348	0.547	0.575	0.984
Group	n	Mature oocytes [n(η/%)]	Normal fertilization [n(η/%)]	Available embryos[n(η/%)]	High-quality embryos[n(η/%)]
Non-tansient premature of LH	105	804(83.6)	666(82.8)	507(76.1)	407(61.1)
Tansient premature of LH	40	340(82.9)	271(79.7)	208(76.8)	157(57.9)
t/χ²		0.087	1.580	0.042	0.812
P		0.768	0.209	0.838	0.368

Group	n	No.of transferred embryos	Transferred blastocysts[n(η/%)]	Implanted embryos[n(η/%)]	Clinical pregnancy[n(η/%)]	Ongoing pregnancy [n(η/%)]
Non-tansient premature of LH	105	2（1,2）	33（31.4）	68（42.0）	60（57.1）	51（48.6）
Tansient premature of LH	40	1.5（1，2）	12（30.0）	22（36.7）	19（47.5）	15（37.5）
Z/χ²		－0.355	0.028	0.512	1.086	1.432
P		0.245	0.868	0.474	0.297	0.231

Variable	Assignment
Premature LH surge	No=0；Yes=1
Basic LH	Quantitative data
Gn duration untill antagonist starting day	Quantitative data
E₂ level on antagonist use day	Quantitative data
Follicle diameter on antagonist use day	Quantitative data

Effect of transient prematur of luteinizing hormone in gonadotropin releasing hormone antagonist flexible protocols on pregnancy outcomes of patients underwent fresh IVF/ICSI-ET cycles

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Feature	B value	Standard error of B value	OR(95%CI)	χ²	P
Basic LH(IU·L^－1)	0.176	0.091	1.193（0.999－1.425）	3.783	0.052
Gn duration untill antagonist starting day（d）	0.416	0.151	1.516(1.128－2.038)	7.588	0.006
E₂ level on antagonist use day (pg·L^－1)	0.885	0.301	2.424(1.345－4.371)	8.670	0.003

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