LH<1.2 IU/l，取卵數較少，胚胎品質較差
http://humrep.oxfordjournals.org/content/21/10/2645.long
A relative reduction in mid-follicular LH concentrations during GnRH agonist IVF/ICSI cycles leads to lower live birth rates
Abstract
BACKGROUND: The effect of early- and mid-follicular LH concentrations on the ovarian response and pregnancy outcomes was evaluated in women receiving pituitary down-regulation with a GnRH agonist and ovarian stimulation with recombinant FSH (rFSH) during IVF/ICSI treatment. METHODS: Blood samples were collected prospectively from 701 cycles (560 patients) of assisted reproduction and analysed retrospectively. On the basis of LH concentrations on stimulation day 7/8, the patients were divided into two groups: LH < 1.2 IU/l (n = 179) and LH ≥ 1.2 IU/l (n = 522). Cycle outcomes were also compared on the basis of a ratio of mid- to early-follicular LH concentrations (≤0.5, n = 210; >0.5, n= 491). RESULTS: Patients with low LH concentrations were found to have a significant reduction in the late-follicular estradiol concentrations (P < 0.001), the number of oocytes retrieved (P < 0.01) and the number of usable embryos (P < 0.01), and they required significantly more rFSH (430 IU difference, P < 0.01). These differences did not translate into a significant change in live birth rates. Conversely, a ratio of ≤0.5 mid- to early-follicular LH concentrations (a reduction of ≥50%) was associated with a significant reduction in live birth rates per embryo transfer and per cycle started (27.3 versus 19.0%, P < 0.05 and 22.2 versus 15.8%, P < 0.05, respectively). CONCLUSIONS: Low mid-follicular levels of LH have a significant impact on ovarian response but not on live birth rates. A fall in LH level of ≥50% from the early- to mid-follicular phase resulted in a lower live birth rate.
Table II.
Outcomes: LH < 1.2 IU/L (day 7/8) vs. LH ≥ 2.8 IU/L (day 7/8)
| Group 1 (LH < 1.2) | Group 2 (LH ≥ 1.2) | Statistical comparison (P-value) | |
|---|---|---|---|
| Average total rFSH used (IU) (SD) | 2423 (±1012) | 1986 (±929) | <0.001 |
| Average final estradiol level (pmol/l) (SD) | 5279 (±3055) | 7500 (±3665) | <0.001 |
| Average number of oocytes collected (SD) | 9.6 (±6.6) | 11.2 (±6.4) | <0.01 |
| Average number of usable embryos (SD) | 2.96 (±2.52) | 3.58 (±2.93) | <0.01 |
| Clinical pregnancy rate per transfer | 35.1% (54/154) | 32.9% (138/420) | ns |
| Clinical pregnancy rate per cycle started | 30.2% (54/179) | 26.4% (138/522) | ns |
| Implantation rate | 29.4% (64/218) | 27.2% (169/621) | ns |
| Miscarriage rate | 28.3% (15/53) | 21.7% (30/138) | ns |
| Multiple pregnancy rate | 7.9% (3/38) | 23.9% (26/109) | <0.05 |
| Live birth rate per transfer | 23.5% (36/153) | 25.2% (106/420) | ns |
| Live birth rate per cycle started | 20.2% (36/178) | 20.3% (106/522) | ns |
- ns, not statistically significant.
沒有留言:
張貼留言