生殖医学杂志2025，Vol.34Issue(6)：741-748,8.DOI:10.3969/j.issn.1004-3845.2025.06.004
扳机日LH水平对高龄DOR患者拮抗剂方案临床结局的影响
Impact of LH level on trigger day on clinical outcomes of antagonist regimens in patients of advanced age with diminished ovarian reserve
摘要
Abstract
Objective:To investigate the effect of LH level on the trigger day on clinical outcomes of an antagonist regimen during IVF-ET in patients of advanced age with diminished ovarian reserve(DOR). Methods:A retrospective analysis of clinical data of DOR patients aged not less than 35 years who underwent fresh embryo transfer cycles at the Reproductive Center of the 900th Hospital from January 2020 to December 2023 was conducted.The baseline characteristics and ovulation promotion parameters of the two groups(clinical pregnancy group and non-clinical pregnancy group)were compared to screen out potential variables related to clinical pregnancy.The predictive value of LH level on the trigger day for clinical pregnancy was analyzed by using a receiver operating characteristic(ROC)curve,and the best cut-off value for predicting clinical pregnancy was determined.With reference to the best cut-off value for LH level on the trigger day,patients were divided into group A(LH＜2.48 U/L on the trigger day)and group B(LH ≥2.48 U/L on the trigger day).Baseline characteristics,clinical ovulation,laboratory parameters and pregnancy outcomes were compared between the two groups.The effect of LH level on the trigger day on clinical outcomes was analyzed with binary logistic regression analysis. Results:There were significant differences in the age,basal FSH level,LH level on the trigger day and antral follicle count(AFC)between the clinical pregnancy group and the non-clinical pregnancy(P＜0.05).There were no significant differences in the age,body mass index(BMI),AFC,infertility duration,the level of anti-Müllerian hormone(AMH)between the group A and group B(P＞0.05).The basal levels of FSH,LH,estradiol(E2)of group A were significantly lower than those of group B(P＜0.05).As for the ovulation induction,the thickness of endometrium,E2 level on the trigger day and progesterone(P)level of the two groups were similar,showing no significant differences(P＞0.05).The number of follicles with a diameter not less than 14 mm,the total amount and the duration of gonadotropin(Gn)use of group A were significantly higher than those of group B(P＜0.05).In terms of laboratory parameters and pregnancy outcomes,the number of oocytes retrieved,MⅡ oocytes,double primordial nuclei(2PN)fertilization and cleavage,and D3 high-quality embryos in group A were significantly higher than those of group B(P＜0.05).Meanwhile,the HCG positive rate,the implantation rate,and clinical pregnancy rate in group A were also significantly higher than those in group B(P＜0.05).The fertilization type,the number of transferred embryos,high-quality blastocyst formation rate,and miscarriage rate of the two groups were similar(P＞0.05).The live birth rate of group A was higher than that of group B,but there was no statistical difference(P＞0.05).The results of binary logistic regression analysis showed that LH level on the trigger day was an independent influence on clinical pregnancy in advanced patients with DOR[OR=0.864,95％CI(0.758,0.986),P＜0.05]. Conclusions:LH level on the trigger day had a high predictive value in elderly DOR patients,and LH≥2.48 U/L could predict a reduced number of recovered oocytes and poor pregnancy outcomes.关键词
拮抗剂方案/高龄/卵巢储备功能减退/扳机日LHKey words
Antagonist regimen/Advanced age/Diminished ovarian reserve/LH level on trigger day分类
医药卫生引用本文复制引用
林琳,陈国勇,黄吴键,熊萍,何凌云,刘芸..扳机日LH水平对高龄DOR患者拮抗剂方案临床结局的影响[J].生殖医学杂志,2025,34(6):741-748,8.基金项目
联勤保障部队第九○○医院院立课题(2020L33) （2020L33）
