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  • Title: [Effects of time of recombinant luteinized hormone supplementation on pregnancy outcomes of women with advanced reproductive age during follicular-phase long protocol].
    Author: Wang L, Wang J, Hu YQ, Liu JY, Diao FY.
    Journal: Zhonghua Fu Chan Ke Za Zhi; 2022 Oct 25; 57(10):758-766. PubMed ID: 36299179.
    Abstract:
    Objective: To investigate the effects of supplementation of recombinant luteinized hormone (rLH) and its timing on pregnancy outcomes of patients at 35 years or older with follicular-phase long protocol. Methods: Clinical data of women undergoing in vitro fertilization or intracytoplasmic sperm injection with follicular-phase long protocol was collected and retrospectively analyzed in the First Affiliated Hospital of Nanjing Medical University from January 2017 to December 2019. There were 558 patients at 35 years or older included in this study, and they were divided into three groups: group A was patients with only recombinant follicle stimulating hormone (rFSH) stimulation (127 cycles), group B was patients with rFSH plus rLH supplementation in the mid-follicular phase (141 cycles), and patients in group C received combined rFSH and rLH from the first day of ovarian stimulation (290 cycles). The basic characteristics of patients of each group were observed and the effects of ovarian simulation and pregnancy outcomes were compared among the three groups. Logistic regression model was performed to explore the association between different groups and pregnancy outcomes. Results: The basic characteristics such as age, duration of infertility, body mass index (BMI) and serum basic follicle stimulating hormone (FSH) were comparable among the three groups (all P>0.05). Anti-Müllerian hormone (AMH), antral follicles count (AFC) and basic luteinized hormone (LH) were significantly lower in group C compared to group A and group B (all P<0.05). There were statistically significant differences in initiation dosage, total dosage and duration of gonadotropin (Gn) among the three groups (all P<0.01), the initiation dosage, total dosage and duration of Gn were higher in group C than the other two groups. The number of oocytes retrieved and available embryos were significantly lower in group B and group C than group A (all P<0.001). In fresh embryo transfer cycles, significantly higher implantation rate (45.3%, 117/258) and clinical pregnancy rate (52.6%, 111/211) were found for group C when compared with group A and group B (P=0.036, P=0.006). The live birth rate in fresh embryo transfer cycles was comparable among the three groups (P=0.098). The implantation rate, clinical pregnancy rate and live birth rate in the subsequent frozen-thawed embryo transfer cycles did not differ significantly among the three groups (all P>0.05). There were no significantly differences in the cumulative pregnancy rate and the cumulative live birth rate among the three groups (all P>0.05). After adjusted for age, BMI, AMH, AFC, basic FSH and LH, total Gn dosage, endometrial thickness at transfer, number of oocytes retrieved, number of embryos transferred and stage of embryo transferred, in fresh embryo transfer cycles, the clinical pregnancy rate (adjusted OR=2.793, 95%CI: 1.512-5.162, P<0.001) and live birth rate (adjusted OR=2.324, 95%CI: 1.241-4.351, P=0.008) were higher in group C, while clinical pregnancy rate and live birth rate were similar between group B and group A in fresh embryo transfer cycles (all P>0.05); there was no significant difference in cumulative live birth rate among the three groups (P>0.05). Conclusions: The supplementation of rLH from the first day of ovarian stimulation improves the pregnancy outcomes of patients at 35 years or older in fresh embryo transfer cycles during follicular-phase long protocol. However, the supplementation of rLH has no benefit on cumulative live birth rate. 目的： 探讨年龄≥35岁的不孕症患者采用早卵泡期长方案促排卵，是否添加重组黄体生成素（rLH）及不同添加时机对妊娠结局的影响。 方法： 回顾性分析2017年1月至2019年12月在南京医科大学第一附属医院行早卵泡期长方案促排卵患者的临床数据，共558例高龄不孕症患者入组，根据是否添加rLH及添加时机分为3组：未添加rLH组127例，中期添加rLH组141例，全程添加rLH组290例。比较3组患者的基本特征、促排卵情况及妊娠结局，采用logistic回归模型分析不同添加方案对新鲜周期妊娠结局及累积活产率的影响。 结果： 3组患者的年龄、不孕年限、体质指数（BMI）、基础卵泡刺激素（FSH）水平有可比性（P均>0.05），全程添加rLH组的基础黄体生成素（LH）、抗苗勒管激素（AMH）和窦卵泡数（AFC）显著低于未添加rLH组和中期添加rLH组（P均<0.05）。3组患者的促性腺激素（Gn）启动剂量、Gn总剂量及Gn刺激时间均有显著差异（P均<0.01），全程添加rLH组的Gn启动剂量和总剂量最大、刺激时间最长。全程添加rLH组和中期添加LH组患者的获卵数和可移植胚胎数显著低于未添加LH组（P均<0.001）。全程添加rLH组患者的新鲜周期种植率（45.3%，117/258）和临床妊娠率（52.6%，111/211）显著高于未添加rLH组和中期添加rLH组（P=0.036、P=0.006），3组之间新鲜周期的活产率无显著差异（P=0.098）。3组患者冻融周期的种植率、临床妊娠率和活产率均无差异（P均>0.05）。3组之间的累积妊娠率及累积活产率均无差异（P均>0.05）。校正年龄、BMI、AMH、AFC、基础FSH、基础LH、Gn总剂量、获卵数、移植日子宫内膜厚度、移植胚胎个数和移植胚胎的发育时期后，同未添加rLH组相比，全程添加rLH组新鲜周期移植的临床妊娠率（调整OR=2.793，95%CI为1.512~5.162，P<0.001）和活产率（调整OR=2.324，95%CI为1.241~4.351，P=0.008）升高，中期添加rLH组的新鲜周期移植的临床妊娠率和活产率均无差异（P均>0.05）；3组之间累积活产率的差异无统计学意义（P>0.05）。 结论： 高龄不孕症患者行早卵泡期长方案促排卵时，全程添加rLH可以提高新鲜周期胚胎移植的种植率、临床妊娠率和活产率，但是不提高累积活产率。.
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