本文選題：體外受精(IVF)　切入點：重組人卵泡刺激素(rFSH)　出處：《南京醫(yī)科大學》2017年博士論文　論文類型：學位論文

【摘要】：IVF促排卵晚卵泡期孕酮升高比較常見,有證據(jù)顯示過早孕酮升高對輔助生殖技術的結(jié)果會產(chǎn)生不利影響,高于某一閾值可以觀察到IVF新鮮周期中持續(xù)妊娠率的下降。卵巢刺激中過早孕酮水平升高的原因尚不完全清楚,研究指出大量FSH刺激是孕酮水平升高的一個原因,HCG和LH活性可能有保護作用,防止可能的過早孕酮升高,這一假設尚存在一些爭議。研究目的:研究體外受精-胚胎移植(IVF-ET)長方案中添加LH活性對IVF-ET晚卵泡期孕酮水平的影響,以及孕酮水平對臨床結(jié)局的不利影響。研究方法:第一部分,回顧性分析南京醫(yī)科大學第一附屬醫(yī)院生殖中心六年間IVF-ET采用長方案及拮抗劑方案進行卵巢刺激的11065例患者,統(tǒng)計HCG日孕酮水平升高的發(fā)生率。其中鮮胚移植的6986例新鮮周期移植患者按HCG日孕酮閾值8nmol/L分為甲組(HCG日孕酮8nmol/L)和乙組(HCG日孕酮≥8nmol/L),比較孕酮水平增高對臨床結(jié)局的不利影響。第二部分,一項納入六個國家批準的具有IVF資質(zhì)的臨床生殖中心中行IVF長方案治療助孕的610患者的前瞻性,多中心,隨機對照臨床試驗,受試者隨機分為2組:A組接受HP-HMG加rFSH(n=305)促排卵,而B組單獨接受rFSH(n = 305)促排卵,比較人絨毛膜促性腺激素(HCG)給藥當天的孕酮水平及其臨床結(jié)局。研究結(jié)果:第一部分:長方案及拮抗劑方案間孕酮升高的的發(fā)生率無統(tǒng)計學差異;年輕患者(≤35歲)與年齡大患者相比(35歲),HCG日孕酮升高的發(fā)生率高。乙組(HCG日孕酮≥8nmol/L)HCG日雌二醇水平、Gn總劑量、獲卵數(shù)、受精率、可移植卵裂期胚胎數(shù)均明顯高于甲組(HCG日孕酮8nmol/L),而臨床妊娠率、種植率、雙胎率、活產(chǎn)率均明顯低于甲組。第二部分:兩組人群基線無統(tǒng)計學意義差異。HCG給藥當天孕酮(P)水平B組(4.3±2.2nmol/1)明顯高于A組(3.8±1.7nmol/1)(P0.05)。獲得卵母細胞數(shù)B組(12.9±5.6)明顯高于A組(11.9±6.0)(P0.05)。受精率B組(69.2%)明顯低于A組(73.9%)(P0.05)。然而,兩組之間的卵裂率,種植率,臨床妊娠率和卵巢過度刺激(OHSS)率無統(tǒng)計學意義差異,但為預防OHSS的鮮胚移植取消率A組(34.8%)明顯(P0.05)低于B組(43.2%)。結(jié)論:第一部分:HCG日孕酮水平升高會對IVF的妊娠結(jié)局會產(chǎn)生不利影響,由于孕酮升高對卵母細胞或胚胎的質(zhì)量沒有影響,可以推測卵巢刺激期間孕酮水平升高改變子宮內(nèi)膜容受性,是妊娠率降低的原因。第二部分:在接受IVF-ET GnRHa長方案的婦女中,與單獨使用rFSH相比,使用HP-HMG加rFSH促排卵hCG當天平均孕酮水平明顯降低,獲卵母細胞數(shù)明顯降低,受精率明顯升高,為預防OHSS的鮮胚移植取消率明顯下降,但其他臨床結(jié)局指標兩組之間沒有差異。臨床試驗注冊號:ChiCTR-TRC-14004552。(中國臨床試驗注冊機構,2014年4月21日)
[Abstract]:The increase of progesterone in late follicular phase of ovulation induced by IVF is more common, and there is evidence that premature progesterone increase has a negative effect on the outcome of assisted reproductive technology. A decrease in the rate of persistent pregnancy during the fresh cycle of IVF can be observed above a certain threshold. The reason for the rise of prematurely progesterone levels in ovarian stimulation is not entirely clear. It has been suggested that a large number of FSH stimuli may be a cause of increased progesterone levels, and that the activities of HCG and LH may have a protective effect against possible premature progesterone elevation. This hypothesis remains controversial. Objective: to study the effect of LH activity on progesterone levels in late follicular phase of IVF-ET. Methods: the first part was to retrospectively analyze 11065 IVF-ET patients who used long regimen and antagonist regimen for ovarian stimulation in the reproductive center of the first affiliated Hospital of Nanjing Medical University during the past six years. According to the HCG daily progesterone threshold value, 6986 fresh embryo transplant patients were divided into two groups: group A (group A) and group B (day progesterone 鈮，

本文編號：1651580