Clinical analysis of high-purity human postmenopausal gonadotropin pretreatment before ovarian stimulation in long-acting protocol

doi:10.3877/cma.j.issn.1673-5250.2021.02.005

Objective

To explore impacts of pretreatment with high-purity human postmenopausal gonadotropin (HP-hMG) before ovarian stimulation in long-acting protocol on clinical pregnancy outcome of sterile females who took in vitro fertilization/intracytoplasmic sperm injection (IVF/ISCI)-embryo transfer (ET).

Methods

A total of 171 sterile females with normal ovarian reserve to whom long-acting IVF/ICSI-ET program for assisted reproduction in Department of Reproductive Medicine of the 980th Hospital of PLA Joint Logistics Support Force from January 2018 to August 2019, were selected as research subjects.Their clinical case data were retrospectively analyzed. According to whether pretreated with HP-hMG before officially launching gonadotropin (Gn) or not, they were divided into study group (n=102, pretreated with HP-hMG ) and control group (n=69, without pretreatment). The general clinical data, relevant clinical indicators during IVF/ICSI-ET for assisted reproduction, related indicators of ET, pregnancy outcome and the incidence of adverse reactions related to assisted reproduction of two groups were statistically compared by independent-samples t test and chi-square test.This study was approved by the Ethics Committee of our hospital (Approval No. 2020-KY-129), and all subjects signed the informed consents.

Results

①There were no significant differences in age, body mass index (BMI), proportion of primary infertility, duration of infertility, basal antral follicle count (AFC) and basal serum hormone levels, including follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol and progesterone between two groups (P>0.05). ②There were no significant differences in serum FSH, LH, estradiol and progesterone levels after down-regulation, serum FSH and estradiol levels on Gn start-up day, the usage days and dose of Gn, serum LH, estradiol and progesterone levels on human chorionic gonadotrophin (hCG) day, and endometrial thickness on transplantation day between two groups (P>0.05). The serum LH level on Gn start-up day of study group was (1.27± 0.81) IU/L, which was significantly higher than that of (0.46±0.21) IU/L in control group, and the difference was statistically significant (t=-8.115, P<0.001). ③There were no significant differences in number of retrieved oocytes, rate of retrieved oocytes, rate of M Ⅱ oocytes, rate of normal fertilization, rate of high-quality embryos, rate of fresh embryo transfer, number of transferred embryos, ratio of IVF to ICSI (IVF/ICSI), rate of clinical pregnancy and spontaneous abortion between two groups (P>0.05). The incidences of moderate and severe ovarian hyperstimulation syndrome (OHSS) and poor ovarian response in study group were both 0, which were significantly lower than those of 4.4% and 5.8% in control group, and the differences were statistically significant (χ²=4.514, P=0.034; χ²=6.055, P=0.014).

Conclusions

On the premise of not increasing Gn using days and its dosage, the pretreatment with HP-hMG before ovulation induction in long-acting protocol of sterile females who took IVF/ICSI-ET for assisted reproduction can lower the occurrence of OHSS and poor ovarian response.

Key words: Menotropins, Ovarian hyperstimulation syndrome, Controlled ovarian hyperstimulation, Fertilization in vitro, Sperm injections, intracytoplasmic, Pregnancy outcome, Female

表1 接受IVF/ICSI-ET助孕的2组受试者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI(kg/m²，±s)	原发不孕者[例数(%)]	不孕年限(年，±s)	基础AFC(个，±s)	基础血清激素水平(±s)
组别	例数	年龄(岁，±s)	BMI(kg/m²，±s)	原发不孕者[例数(%)]	不孕年限(年，±s)	基础AFC(个，±s)	FSH(IU/L)	LH(IU/L)	雌二醇(pmol/L)	孕酮(mg/L)
研究组	102	28.3±3.2	23.3±3.1	50(49.0)	3.3±2.1	15.3±2.3	6.1±1.3	4.8±1.3	166.2±16.5	0.74±0.23
对照组	69	29.0±2.7	22.3±3.2	39(56.5)	3.1±2.0	15.5±2.3	6.3±1.2	4.9±1.3	163.7±17.8	0.76±0.26
检验值		t＝-1.332	t＝0.236	χ²＝7.363	t＝0.716	t＝-0.684	t＝-1.096	t＝-0.523	t＝0.154	t＝-0.522
P值		0.724	0.744	0.061	0.099	0.831	0.275	0.601	0.293	0.622

表1 接受IVF/ICSI-ET助孕的2组受试者一般临床资料比较

组别	例数	年龄(岁，±s)	BMI(kg/m²，±s)	原发不孕者[例数(%)]	不孕年限(年，±s)	基础AFC(个，±s)	基础血清激素水平(±s)
组别	例数	年龄(岁，±s)	BMI(kg/m²，±s)	原发不孕者[例数(%)]	不孕年限(年，±s)	基础AFC(个，±s)	FSH(IU/L)	LH(IU/L)	雌二醇(pmol/L)	孕酮(mg/L)
研究组	102	28.3±3.2	23.3±3.1	50(49.0)	3.3±2.1	15.3±2.3	6.1±1.3	4.8±1.3	166.2±16.5	0.74±0.23
对照组	69	29.0±2.7	22.3±3.2	39(56.5)	3.1±2.0	15.5±2.3	6.3±1.2	4.9±1.3	163.7±17.8	0.76±0.26
检验值		t＝-1.332	t＝0.236	χ²＝7.363	t＝0.716	t＝-0.684	t＝-1.096	t＝-0.523	t＝0.154	t＝-0.522
P值		0.724	0.744	0.061	0.099	0.831	0.275	0.601	0.293	0.622

表2 2组受试者接受IVF/ICSI-ET助孕中相关临床指标比较(±s)

组别	例数	垂体降调节后血清激素水平				Gn启动日血清激素水平
组别	例数	FSH(IU/L)	LH(IU/L)	雌二醇(pmol/L)	孕酮(mg/L)	FSH(IU/L)	LH(IU/L)	雌二醇(pmol/L)
研究组	102	2.7±0.4	0.43±0.20	85.1±11.7	0.63±0.25	2.9±0.6	1.27±0.81	88.8±12.8
对照组	69	2.8±0.6	0.46±0.21	85.1±12.5	0.61±0.23	2.8±0.6	0.46±0.21	85.1±12.5
t值		1.263	0.843	-0.016	-0.492	-1.238	-8.115	-1.793
P值		0.208	0.400	0.987	0.623	0.217	<0.001	0.075
组别	例数	Gn使用时间(d)	Gn使用剂量(IU)	hCG日血清激素水平			移植日子宫内膜厚度(mm)
组别	例数	Gn使用时间(d)	Gn使用剂量(IU)	LH(IU/L)	雌二醇(pmol/L)	孕酮(mg/L)	移植日子宫内膜厚度(mm)
研究组	102	12.7±1.6	2 639±573	1.4±0.8	13 573±3 941	0.81±0.24	11.4±1.3
对照组	69	12.5±1.8	2 753±706	1.2±0.8	13 544±2 316	0.85±0.25	11.3±1.4
t值		-1.028	0.290	-1.126	-0.095	-1.124	-0.496
P值		0.305	0.772	0.262	0.924	0.262	0.620

表2 2组受试者接受IVF/ICSI-ET助孕中相关临床指标比较(±s)

组别	例数	垂体降调节后血清激素水平				Gn启动日血清激素水平
组别	例数	FSH(IU/L)	LH(IU/L)	雌二醇(pmol/L)	孕酮(mg/L)	FSH(IU/L)	LH(IU/L)	雌二醇(pmol/L)
研究组	102	2.7±0.4	0.43±0.20	85.1±11.7	0.63±0.25	2.9±0.6	1.27±0.81	88.8±12.8
对照组	69	2.8±0.6	0.46±0.21	85.1±12.5	0.61±0.23	2.8±0.6	0.46±0.21	85.1±12.5
t值		1.263	0.843	-0.016	-0.492	-1.238	-8.115	-1.793
P值		0.208	0.400	0.987	0.623	0.217	<0.001	0.075
组别	例数	Gn使用时间(d)	Gn使用剂量(IU)	hCG日血清激素水平			移植日子宫内膜厚度(mm)
组别	例数	Gn使用时间(d)	Gn使用剂量(IU)	LH(IU/L)	雌二醇(pmol/L)	孕酮(mg/L)	移植日子宫内膜厚度(mm)
研究组	102	12.7±1.6	2 639±573	1.4±0.8	13 573±3 941	0.81±0.24	11.4±1.3
对照组	69	12.5±1.8	2 753±706	1.2±0.8	13 544±2 316	0.85±0.25	11.3±1.4
t值		-1.028	0.290	-1.126	-0.095	-1.124	-0.496
P值		0.305	0.772	0.262	0.924	0.262	0.620

表3 接受IVF/ICSI-ET助孕的2组受试者ET相关指标、妊娠结局及不良反应比较

组别	例数	获卵数(个，±s)	获卵率[%(n/n′)]	MⅡ卵率[%(n/n′)]	正常受精率[%(n/n′)]	优质胚胎率[%(n/n′)]	鲜胚移植率[%(n/n′)]
研究组	102	14.5±4.3	90.5(1 473/1 627)	89.5(1 318/1 473)	71.3(940/1 318)	45.3(426/940)	75.5(77/102)
对照组	69	15.1±4.5	88.4(1 044/1 181)	89.4(933/1 044)	70.5(558/792)	40.9(228/558)	73.9(51/69)
检验值		t＝0.893	χ²＝3.358	χ²＝0.008	χ²＝0.180	χ²＝2.830	χ²＝0.054
P值		0.373	0.067	0.930	0.671	0.093	0.816
组别	例数	移植胚胎数(个，±s)	IVF/ICSI[%(n/n′)]	临床妊娠率[%(n/n′)]	自然流产率[%(n/n′)]	中、重度OHSS发生率[%(n/n′)]	卵巢低反应发生率[%(n/n′)]
研究组	102	1.5±0.9	17.2(15/87)	71.4(55/77)	10.9(6/55)	0(0/102)	0(0/102)
对照组	69	1.5±0.9	25.5(14/55)	54.9(28/51)	10.7(3/28)	4.4(3/69)	5.8(4/69)
检验值		t＝-0.019	χ²＝1.399	χ²＝3.676	χ²＝0.001	χ²＝4.514^a	χ²＝6.055^a
P值		0.985	0.237	0.055	0.978	0.034	0.014

表3 接受IVF/ICSI-ET助孕的2组受试者ET相关指标、妊娠结局及不良反应比较

组别	例数	获卵数(个，±s)	获卵率[%(n/n′)]	MⅡ卵率[%(n/n′)]	正常受精率[%(n/n′)]	优质胚胎率[%(n/n′)]	鲜胚移植率[%(n/n′)]
研究组	102	14.5±4.3	90.5(1 473/1 627)	89.5(1 318/1 473)	71.3(940/1 318)	45.3(426/940)	75.5(77/102)
对照组	69	15.1±4.5	88.4(1 044/1 181)	89.4(933/1 044)	70.5(558/792)	40.9(228/558)	73.9(51/69)
检验值		t＝0.893	χ²＝3.358	χ²＝0.008	χ²＝0.180	χ²＝2.830	χ²＝0.054
P值		0.373	0.067	0.930	0.671	0.093	0.816
组别	例数	移植胚胎数(个，±s)	IVF/ICSI[%(n/n′)]	临床妊娠率[%(n/n′)]	自然流产率[%(n/n′)]	中、重度OHSS发生率[%(n/n′)]	卵巢低反应发生率[%(n/n′)]
研究组	102	1.5±0.9	17.2(15/87)	71.4(55/77)	10.9(6/55)	0(0/102)	0(0/102)
对照组	69	1.5±0.9	25.5(14/55)	54.9(28/51)	10.7(3/28)	4.4(3/69)	5.8(4/69)
检验值		t＝-0.019	χ²＝1.399	χ²＝3.676	χ²＝0.001	χ²＝4.514^a	χ²＝6.055^a
P值		0.985	0.237	0.055	0.978	0.034	0.014

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