體外受精週期中卵巢刺激之早發性黃體化並不影響其懷孕結果

Premature Luteinization during Ovarian Stimulation did not Affect Pregnancy Outcome in in Vitro Fertilization Cycles

卵巢刺激之早發性黃體化在體外受精週期中並不罕見，其影響層面與成因至今仍不十分確定。本研究係由1996年1月至1997年10月於本院接受體外受精助孕治療並植入2～5個胚胎之婦女中，扣除卵子捐贈以及沒有合併使用促性線激素釋放素類似物(GnRHa)、人類停經促性線激(hMG)及濾泡刺激激素(FSH)刺激卵巢的病人，以所餘266個週期的病人為統計對象。我們以注射人類絨毛促性腺激素(hCG)當天血清中黃 體素濃度0.9 ng/mL 為界將前述病人分為二組，其中濃度≦ 0.9 ng/mL者共113個週期 ，濃度 ＞ 0.9 ng/mL者（定義為早發性黃體化）共153個週期。再將接受經陰道胚胎植入(ET)與經輸卵管胚胎植入(TET)的病人分別統計，結果發現在ET週期中，黃體素濃度≦ 0.9 ng/mL的懷孕率與著床率（35.6%及10.2%）高於濃度 ＞ 0.9 ng/mL時（24.2%及8.3%），但無統計上顯著差異。在TET週期中，黃體素濃度≦ 0.9 ng/mL 與濃度 ＞ 0.9 ng/mL的懷孕率非常接近(48.5% vs. 49.5%)，著床率則前者較高(18.9% vs. 15.8 %）。此外，黃體素濃度 ＞ 0.9 ng/mL 時有較高的血清雌二醇(E2)濃度（ET與TET週期，p值＜ 0.005）、血清黃體化激素(LH)濃度（ET週期，p值＜ 0.05 ）、濾泡數（TET週期，p值＜ 0.05 ）與取卵數（TET週期，p值＜ 0.01 ）。受精率、品質良好的卵子及胚胎之百分比均與黃體素濃度高低無關。接受體外受精治療的婦女一旦懷孕，早期流產或子宮外孕的危險性並不因濾泡期之黃體素濃度升高而增加。我們的結論是早發性黃體化常見於體外受精週期中濾泡數與取卵數較多時，以及注射hCG當天E2與LH血清濃度較高的婦女，但它並不影響懷孕率與著床率。而且，發生早發性黃體化的婦女一旦懷孕，其預後並不會較差。

Premature luteinization during ovarian stimulation is common in vitro fertilization(IVF) cycles. Its cause and possible deleterious effects are still under investigation. We retrospectively studied impact of premature luteinization in women undergoing IVF at National Taiwan University Hospital from 1996 January to 1997 October. Oocyte donors as well as women who did not receive gonadotropin releasing hormone analogue (GnRHa) combined with human menopausal gonadotropin (hMG) and follicle stimulating hormone(FSH) for ovarian stimulation were excluded from this study. There were 266 cycles in which women received 2 to 5 transferred embryos. Of there, there were 113 cycles with progesterone (P4) levels ≦ 0.9 ng/mL on the day of human chorionic gonadotropin (hCG) administration, and 153 cycles with P4 > 0.9 ng/mL (defined as premature luteinization). The data were analyzed separately in embryo transfer (ET) and tubal embryo transfer (TET) cycles. The results revealed that pregnancy rates were not significantly different between cycles with or without premature lsteinization, in either ET (35.6% vs. 24.2%) or TET (48.5% vs. 49.5%) cycles. Estradiol (E2, p < 0.005 in both ET and TET cycles) and luteinizing hormone (LH, p < 0.005 in ET cycles) levels on the day of hCG administration as well as follicle ( p < 0.05 in TET cycles) and aoocyte ( p < 0.01 in TET cycles) numbers were apparently higher for women with premature luteinization. Nevertheless, the fertilization rate and the rates of good-quality oocytes and embryos were similar in cycles with and without premature luteninization. The incidences of early pregnancy loss and ectopic pregnancy were also similar between the two groups. We conclude that premature luteinization is associated with more recruited follicles and more retrieved oocytes as well as higher levels of E2 and LH on the day of hCG administration in IVF. However, P4 levels evidently do not affect the pregnancy rate and outcome.