短期同步添加小剂量生长激素在体外受精失败患者再次助孕中的应用研究

Clinical effect of short-term low-dose growth hormone supplementation in promoting pregnancy in patients with previous in vitro fertilization failure

摘要:

目的：研究体外受精-胚胎移植（in vitro fertilization-embryo transfer，IVF-ET）助孕中同步添加小剂量生长激素（growth hormone，GH）对胚胎质量及助孕结局的影响。方法：以2017年9月至2018年9月，前一周期IVF助孕未获优质胚胎且未获成功妊娠的76例年轻患者（＜37岁）为研究对象，再次助孕采用与前一周期相同的促排卵方案，控制性超排卵（controlled ovarian hyperstimulation，COH）期间同步添加小剂量生长激素，采用自身对照，比较患者前后两次助孕的Gn时间、获卵数、获可移植胚胎数、优胚率、子宫内膜厚度、临床妊娠率、着床率和生化/临床妊娠流产率等。结果：患者添加GH后，促排卵Gn用药总量、停Gn日血清雌二醇水平、停Gn日宫内膜厚度、获卵数、平均可移植胚胎数较前一周期均无统计学差异，无可移植胚胎周期取消率相似（P>0.05），但添加GH后Gn用药天数缩短[（10.39±1.38） d vs. （11.14±1.78） d，P=0.004]，优质胚胎率（18.9% vs. 0.0%）、临床妊娠率[51.32%（39/76） vs. 7.89%（6/76）]、着床率[38.73%（55/142） vs. 5.00%（7/140）]均显著提高，差异有统计学意义（P<0.05），生化/临床妊娠流产率无统计学差异（P>0.05）。结论：无明确原因胚胎质量差的患者，再次IVF助孕同步添加小剂量GH，能获得理想的助孕结局。

Abstract:

Objective：To investigate the effect of low-dose growth hormone（GH） supplementation on embryo quality and pregnancy outcome in patients undergoing in vitro fertilization-embryo transfer（IVF-ET）. Methods：From September 2017 to September 2018，76 young patients，aged <37 years，who did not obtain a high-quality embryo or achieve successful pregnancy after the previous cycle of IVF，were enrolled as subjects. In the subsequent cycle，the same regimen for ovulation induction was used，and low-dose GH was provided as a supplement during controlled ovarian hyperstimulation（COH）. A self-control study was performed to compare duration of gonadotropin（Gn），number of retrieved oocytes，number of transplantable embryos，rate of high-quality embryos，endometrial thickness，clinical pregnancy rate，implantation rate，and chemical or clinical pregnancy loss rate between the two cycles. Results：After the supplementation with GH，there were no significant changes in the total amount of Gn，serum estradiol level on the day of Gn withdrawal，endometrial thickness on the day of Gn withdrawal，number of retrieved oocytes，average number of transplantable embryos，and rate of cancellation due to no transplantable embryos（P>0.05），but there was a significant reduction in the number of days of Gn administration（10.39±1.38 vs. 11.14±1.78，P=0.004） and significant increases in the rate of high-quality embryos（18.9% vs. 0.0%），clinical pregnancy rate[51.32%（39/76） vs. 7.89% （6/76）]，and implantation rate [38.73%（55/142） vs. 5.00%（7/140）]. There were no significant change in chemical or clini－cal pregnancy loss rate（P>0.05）. Conclusion：For patients with poor embryo quality of unknown causes，low-dose GH supple－mentation in the second cycle of IVF can help to achieve a good pregnancy outcome.