摘要
目的针对高龄合并卵巢储备功能减退症(DOR)患者,在体外受精-胚胎移植(IVF-ET)过程中应用拮抗剂方案,探讨扳机日黄体生成素(LH)水平对临床结局的影响。方法回顾性分析2020年1月至2023年12月在第九○○医院生殖中心行鲜胚移植周期的高龄(≥35岁)DOR患者的临床资料,对两组患者(临床妊娠组与非临床妊娠组)的基线特征及促排卵参数进行组间比较,筛选出与临床妊娠相关的潜在变量;采用受试者工作特征(ROC)曲线,分析扳机日LH水平对临床妊娠的预测价值并确定其预测临床妊娠的最佳截断值;参照扳机日LH最佳截断值,再将患者分为A组(扳机日LH<2.48 U/L)和B组(扳机日LH≥2.48 U/L),比较两组患者的基线特征、临床促排卵及实验室参数和妊娠结局,并对扳机日LH水平对临床结局影响进行二元Logisitic回归分析。结果(1)根据妊娠结局,分为临床妊娠组和非临床妊娠组,两组患者的年龄、基础卵泡刺激素(FSH)、扳机日LH、窦卵泡数(AFC)水平均有统计学差异(P<0.05)。(2)根据ROC曲线最佳阈值分成的A、B两组患者的年龄、体质量指数(BMI)、AFC、不孕年限、抗苗勒管激素(AMH)水平均无显著性差异(P>0.05),但A组基础状态下FSH、LH、雌二醇(E_(2))水平均显著低于B组(P<0.05);促排卵情况比较:两组患者的内膜厚度、扳机日的E_(2)、孕酮(P)水平比较接近,差异均无统计学意义(P>0.05),而A组≥14 mm卵泡数、Gn总量、Gn天数均显著高于B组(P<0.05);实验室参数及妊娠结局比较:A组获卵数、MⅡ卵数、双原核(2PN)受精及卵裂数量、D3优胚数量均显著多于B组(P<0.05),A组的HCG阳性率、种植率及临床妊娠率也显著高于B组(P<0.05);两组患者的受精类型、移植胚胎的数量、优质囊胚形成率及流产率均相似(P>0.05),A组的活产率高于B组,但尚无统计学差异(P>0.05)。(3)二元Logisitic回归分析结果显示,扳机日LH水平是高龄DOR患者临床妊娠的独立影响因素[OR=0.864,95%CI(0.758,0.986),P<0.05]。结论扳机日LH水平对高龄DOR患者的临床妊娠结局具有较高的预测价值,LH≥2.48 U/L可预测回收的卵母细胞数量减少及不良妊娠结局。
Objective:To investigate the effect of LH level on the trigger day on clinical outcomes of an antagonist regimen during IVF-ET in patients of advanced age with diminished ovarian reserve(DOR).Methods:A retrospective analysis of clinical data of DOR patients aged not less than 35 years who underwent fresh embryo transfer cycles at the Reproductive Center of the 900th Hospital from January 2020 to December 2023 was conducted.The baseline characteristics and ovulation promotion parameters of the two groups(clinical pregnancy group and non-clinical pregnancy group)were compared to screen out potential variables related to clinical pregnancy.The predictive value of LH level on the trigger day for clinical pregnancy was analyzed by using a receiver operating characteristic(ROC)curve,and the best cut-off value for predicting clinical pregnancy was determined.With reference to the best cut-off value for LH level on the trigger day,patients were divided into group A(LH<2.48 U/L on the trigger day)and group B(LH≥2.48 U/L on the trigger day).Baseline characteristics,clinical ovulation,laboratory parameters and pregnancy outcomes were compared between the two groups.The effect of LH level on the trigger day on clinical outcomes was analyzed with binary logistic regression analysis.Results:There were significant differences in the age,basal FSH level,LH level on the trigger day and antral follicle count(AFC)between the clinical pregnancy group and the non-clinical pregnancy(P<0.05).There were no significant differences in the age,body mass index(BMI),AFC,infertility duration,the level of anti-Müllerian hormone(AMH)between the group A and group B(P>0.05).The basal levels of FSH,LH,estradiol(E_(2))of group A were significantly lower than those of group B(P<0.05).As for the ovulation induction,the thickness of endometrium,E_(2)level on the trigger day and progesterone(P)level of the two groups were similar,showing no significant differences(P>0.05).The number of follicles with a diameter not less than 14 mm,the total amount and the duration of gonadotropin(Gn)use of group A were significantly higher than those of group B(P<0.05).In terms of laboratory parameters and pregnancy outcomes,the number of oocytes retrieved,MII oocytes,double primordial nuclei(2PN)fertilization and cleavage,and D3 high-quality embryos in group A were significantly higher than those of group B(P<0.05).Meanwhile,the HCG positive rate,the implantation rate,and clinical pregnancy rate in group A were also significantly higher than those in group B(P<0.05).The fertilization type,the number of transferred embryos,high-quality blastocyst formation rate,and miscarriage rate of the two groups were similar(P>0.05).The live birth rate of group A was higher than that of group B,but there was no statistical difference(P>0.05).The results of binary logistic regression analysis showed that LH level on the trigger day was an independent influence on clinical pregnancy in advanced patients with DOR[OR=0.864,95%CI(0.758,0.986),P<0.05].Conclusions:LH level on the trigger day had a high predictive value in elderly DOR patients,and LH≥2.48 U/L could predict a reduced number of recovered oocytes and poor pregnancy outcomes.
作者
林琳
陈国勇
黄吴键
熊萍
何凌云
刘芸
LIN Lin;CHEN Guo-yong;HUANG Wu-jian;XIONG Ping;HE Ling-yun;LIU Yun(Center for Reproductive Medicine,900th Hospital of PLA Joint Logistics Support Force,Fuzhou 350025)
出处
《生殖医学杂志》
2025年第6期741-748,共8页
Journal of Reproductive Medicine
基金
联勤保障部队第九○○医院院立课题(2020L33)。
关键词
拮抗剂方案
高龄
卵巢储备功能减退
扳机日LH
Antagonist regimen
Advanced age
Diminished ovarian reserve
LH level on trigger day
