本文選題：血清黃體生成素 + 微刺激��； 參考：《上海交通大學(xué)》2014年碩士論文

【摘要】：目的：采用病例對(duì)照研究方法，探討在全胚冷凍移植的前提下，微刺激促排卵過(guò)程發(fā)生高血清黃體生成素水平對(duì)于不孕癥患者IVF結(jié)局的影響。 方法：采用病例對(duì)照研究方法，回顧性分析2012年10月至2013年10月間在上海交通大學(xué)醫(yī)學(xué)院附屬第九人民醫(yī)院輔助生殖科接受IVF/ICSI治療患者共180例，觀察在微刺激促排期間出現(xiàn)高血黃體生成素水平病例90例，對(duì)照組按年齡、不孕年限、不孕原因、周期用藥方案等因素與病例組嚴(yán)格1：1配對(duì)，從接受IVF/ICSI治療的患者中隨機(jī)抽取。根據(jù)卵巢儲(chǔ)備功能及不孕癥背景差異，分為卵巢功能正常組、多囊卵巢組，卵巢隱性衰竭組三組，將各組病例組與對(duì)照組獲卵數(shù)、受精率、卵裂率、有效胚胎率等胚胎實(shí)驗(yàn)室結(jié)局進(jìn)行對(duì)比分析。以全胚冷凍及凍融胚胎移植策略為前提，對(duì)于病例組與對(duì)照組的胚胎種植率，生化妊娠率及臨床妊娠率進(jìn)行對(duì)比分析。 結(jié)果:納入研究人群中，病例組與對(duì)照組在年齡（36.0±5.9歲 vs. 36.1±5.4歲）、不孕年限（4.90±4.30年 vs. 4.87±3.98年）、既往無(wú)可用胚胎周期數(shù)（2.41±2.65 vs. 2.17±2.16）及既往移植失敗次數(shù)（1.10±1.64 vs. 1.06±1.84），均無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。 卵巢功能正常組中，病例組患者在促排卵期間LH水平12.81±3.07 mIU/mL明顯高于對(duì)照組5.60±4.88 mIU/mL，P0.05,而病例組促排期間孕酮值（0.26±0.15 ng/mL vs. 0.25±0.10 ng/mL）、平均獲卵數(shù)（2.70±1.67枚 vs. 3.0±1.85枚）、受精率（74.2% vs. 73.9%）、成熟卵率（98.39% vs. 97.1%）、卵裂率（97.8% vs. 98.0%）及優(yōu)胚率（97.8% vs. 98.0%），無(wú)明顯統(tǒng)計(jì)學(xué)差異（P0.05）。在凍融胚胎移植條件下，病例組卵巢能正�；颊邔�(duì)照組在生化妊娠率（64.2% vs. 64.7%）、種植率（36.8% vs. 40.7%）、臨床妊娠率（50% vs. 52.9%）與對(duì)照組均無(wú)顯著差異（P0.05）。 多囊卵巢組中，病例組在平均獲卵（6.86±3.35枚 vs. 6.67±3.40枚）、成熟卵率（90.7% vs. 87.6%）、卵裂率（97.1% vs. 96.3%）、優(yōu)質(zhì)胚胎率（63.6% vs. 68.3%），均無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。兩組在移植解凍胚胎后生化妊娠率（61.5% vs. 61.9%）及臨床妊娠率（53.8% vs. 57.1%），無(wú)明顯統(tǒng)計(jì)學(xué)差別。 卵巢隱性衰竭組中，病例組與對(duì)照組在受精率（97.91% vs. 94.29%），卵裂率（42.47% vs. 49.31%），，均無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。在優(yōu)質(zhì)胚胎數(shù)上，病例組平均1.29±0.49枚與對(duì)照組1.24±0.53枚相比無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。在冷凍胚胎移植結(jié)局，卵巢隱性衰竭患者病例組與對(duì)照組在種植率（36.8% vs. 33.3%），無(wú)統(tǒng)計(jì)學(xué)差異（P0.05）。而病例組在生化妊娠率（46.7% vs. 40.0%），臨床妊娠率（40% vs. 35%）高于對(duì)照組，具有顯著統(tǒng)計(jì)學(xué)差異，P0.05，可能與兩組移植病例數(shù)較少有關(guān)。 結(jié)論：本研究觀察到微刺激促排卵過(guò)程中高血LH水平對(duì)于患者IVF/ICSI結(jié)局并無(wú)顯著影響，提示高LH狀態(tài)下依然可以獲得具有成熟的卵母細(xì)胞和具有發(fā)育潛力的胚胎，通過(guò)移植獲得妊娠。
[Abstract]:Objective: to investigate the effect of high serum luteinizing hormone (LPO) level on the outcome of IVF in infertile patients with microstimulation and ovulation stimulation under the premise of whole embryo cryopreservation.Methods: from October 2012 to October 2013, 180 IVF/ICSI patients were treated with IVF/ICSI in the Department of Auxiliary Reproduction of the Ninth affiliated people's Hospital, Shanghai Jiaotong University Medical College, from October 2012 to October 2013, using a case-control study.90 cases with high luteinizing hormone level were observed during microstimulation. The control group was matched with the patient group at 1:1 strictly according to age, length of infertility, cause of infertility, and periodic medication regimen, and was randomly selected from the patients receiving IVF/ICSI treatment.According to the difference of ovarian reserve function and infertility background, the patients were divided into three groups: normal ovarian function group, polycystic ovary group and recessive ovarian failure group.The effective embryo rate and other embryo laboratory outcomes were compared and analyzed.The embryo implantation rate, biochemical pregnancy rate and clinical pregnancy rate of the case group and the control group were compared and analyzed on the premise of the whole embryo freezing and freeze-thawing embryo transfer strategy.In the normal ovarian function group,Under the condition of frozen-thawed embryo transfer, there was no significant difference in biochemical pregnancy rate (64.2% vs .64.7%), implantation rate (36.8% vs .40.7%) and clinical pregnancy rate (50% vs .52.9%) between the control group and the control group.In the polycystic ovary group, the average number of oocytes was 6.86 鹵3.35 vs 6.67 鹵3.40, the maturation rate was 90.7% vs 87.6%, the cleavage rate was 97.1% vs 96.3cm, and the high quality embryo rate was 63.6% vs 68.30.There was no significant difference between the two groups (P 0.05).The biochemical pregnancy rate (61.5% vs. 61.9%) and the clinical pregnancy rate (53.8% vs. 57.1%) were not significantly different between the two groups.In the recessive ovarian failure group, the fertilization rate was 97.91% vs 94.29%, the cleavage rate was 42.47% vs 49.31%, there was no significant difference between the two groups (P 0.05).There was no significant difference in the number of high quality embryos between the case group and the control group (1.29 鹵0.49 vs 1.24 鹵0.53).In the outcome of cryopreservation embryo transfer, the implantation rate of patients with recessive ovarian failure was 36.8% vs 33.30.There was no significant difference between the two groups (P 0.05).The biochemical pregnancy rate of 46.7% vs. 40.0% and the clinical pregnancy rate of 40% vs. 35) in the case group were significantly higher than those in the control group (P 0.05), which may be related to the small number of transplant cases in the two groups.Conclusion: in this study, it was observed that high blood LH level had no significant effect on the outcome of IVF/ICSI in patients with ovulation induced by microstimulation, suggesting that mature oocytes and embryos with developmental potential could still be obtained under the condition of high LH.Pregnancy is obtained by transplantation.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.8

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