拮抗剂方案扳机后HCG、LH水平对IVF/ICSI-ET结局的影响

蔡文元 康卉娴 王荟 张燕

【摘要】目的：探討拮抗剂方案扳机后HCG、LH水平对IVF/ICSI-ET结局的影响。方法：2021年12月—2022年6月在我院生殖医学中心采用拮抗剂方案行IVF/ICSI-ET助孕的患者共282例，按扳机后血清HCG、LH水平分成三组：A组（HCG≥50U/L且LH≥50U/L）115例；B组：（HCG<50U/L且LH>50U/L或HCG>50U/L且LH<50U/L）92例；C组：（HCG<50U/ L且LH<50U/L）75例。比较各组间的一般资料及临床结局资料。结果：A组到C组Gn天数呈逐渐升高趋势，其中A组与C组间差异具有统计学意义（P<0.05）。Gn总量从A组到C组亦呈逐渐升高趋势，其中A组与C组、B组与C组差异具有统计学意义（P<0.05）。B组获卵数高于A组与C组且差异具有统计学意义（P<0.05），A组与C组间差异无统计学意义（P>0.05）。三组移植胚胎数、获卵率、优质胚胎数、优胚率比较差异均无统计学意义（P>0.05）。A组临床妊娠率高于B组与C组，且A组与C组间差异具有统计学意义（P<0.05）。结论：拮抗剂方案中GnRH-a+HCG双扳机后，其临床结局可能与扳机后HCG及LH上升水平有关，HCG及LH高水平可能对临床结局产生有利影响；同时，扳机后LH及HCG水平与体重指数相关，因此，可能在促排卵扳机时需要根据体重指数适当调整用药剂量以便获得更好的临床结局。

【关键词】HCG水平；LH水平；妊娠率；体外受精-胚胎移植

Effect of HCG and LH levels after triggering of antagonist regimen on IVF/ICSI-ET outcomes

CAI Wenyuan， KANG Huixian， WANG Hui， ZHANG Yan

Reproductive Medicine Center，Maternal and Child Health Hospital of Yinchuan， Yinchuan， Ningxia 750001， China

【Abstract】Objective： To investigate the effect of HCG and LH levels on the outcome of IVF/ICSI-ET after the trigger of antagonist regimen. Methods： From December 2021 to June 2022，A total of 282 cases of IVF/ICSI-ET assisted pregnancy were treated with antagonist regimen in the reproductive medical center of our hospital.According to the serum HCG and LH levels after the trigger，the patients were divided into three groups：Group A （115 cases，HCG≥50U/L and LH≥50U/L）；Group B ：（HCG<50U/L and LH>50U/L or HCG>50U/L and LH<50U/ L） 92 cases；Group C ：（HCG < 50U/L and LH< 50U/L） 75 cases.The general data and clinical outcome data were compared between the groups. Results： The days of Gn increased gradually from group A to group C，and the difference between group A and group C was statistically significant（P<0.05）.The total amount of Gn also showed a gradually increasing trend from group A to group C，the difference between group A and group C，group B and group C was statistically significant（P<0.05）.The number of oocytes retrieved in group B was significantly higher than that in group A and group C（P<0.05），but there was no significant difference between group A and group C（P>0.05）.There were no significant differences in the number of transferred embryos，the rate of oocyte retrieval，the number of high-quality embryos and the rate of excellent embryos among the three groups（P>0.05）.The clinical pregnancy rate of group A was higher than that of group B and group C，and the difference between group A and group C was statistically significant （P<0.05）. Conclusion： The clinical outcome after GnRH-a +HCG double trigger in the antagonist regimen may be related to the rising levels of HCG and LH after the trigger，and the high levels of HCG and LH may have a beneficial effect on the clinical outcome；At the same time，LH and HCG levels after triggering are correlated with body mass index. Therefore，it may be necessary to adjust the dosage according to body mass index during triggering ovulation to obtain better clinical outcomes.

【Key？Words】HCG levels；LH level； The pregnancy rate； In vitro fertilization - embryo transfer

自第一例试管婴儿诞生至今，全球约有超过800万试管婴儿出生，显然辅助生殖技术已成为帮助不孕症患者解决生育问题的助孕的主要治疗方法[1]。而控制性超促排卵（COS）是体外受精-胚胎移植助孕治疗中的关键环节，近年来，研究表明拮抗剂方案在超促排卵的安全性和有效性方面呈现出诸多优势，越来越受到生殖临床医生的认可[2-3]。

育龄期妇女的自然周期中，当卵泡生长至近排卵期时雌激素的正反馈作用下诱发黄体生成素峰（LH），促使卵母细胞完成第一次减数分裂及排卵[4]。在传统的COS中往往使用人绒毛膜促性腺激素（HCG）来扳机，因为HCG与LH具有部分相同的分子结构亚单位[5]，但同时卵巢过度刺激综合征（OHSS）的发生与HCG的用量显著相关[6]。目前研究表明拮抗剂方案（GnRH-ant）使用促性腺激素释放激素激动剂（GnRH-a）联合HCG双扳机可明显改善IVF/ICSI-ET的治疗结局[7]。近年来，有学者证实在GnRH-a方案中其治疗结局与扳机后HCG水平存在相关性[8-9]，但对于拮抗剂方案中使用双扳机后血清HCG、LH水平是否与治疗结局相关尚不明确。因此，本……