| Part I The Effect of the Elevated Luteinizing Hormone on In-vitro Fertilization and Embryo Transfer in Patients with PCOSObjectiveThe basic characteristics,COH-cycle characteristics,laboratory characteristics and pregnancy outcomes of IVF-ET in two groups of PCOS patients with different basal LH and LH/FSH ratio at the beginning of controlled ovarian hyperstimulation were retrospectively analyzed,to investigate the effect of elevated basal luteinizing hormone and the ratio of luteinizing hormone to follicle stimulating hormone on IVF-ET in patients with PCOS.MethodA retrospective analysis was made of 639 cases of infertility patients with PCOS who underwent IVF/ICSI-ET treatment in Infertility Clinic Center,Qilu Hospital of Shandong University,from Jan.2018 to Dec.2020.According to the level of LH when they started to IVF/ICSI treatment,the patients were divided into two groups:group A1(n=149)with LH≥10mIU/ml and group A2(n=490)with LH<10mIU/ml.Then the patients were divided into two groups:group B1(n=96)with LH/FSH≥2 and group B2(n=543)with LH/FSH<2 according to LH/FSH ratio.Record and analyze the basic characteristics of patients(age,BMI,years of infertility,AMH,basal FSH,E2,P,T,TSH,PRL),COH-cycle characteristics(dosage and days of Gn,E2,LH,P levels on HCG day,endometrial thickness,number and rate of obtained oocytes),laboratory characteristics(2PN fertilization rate,2PN cleavage rate,high quality embryo rate,blastocyst rate,retrieved oocytes freezing rate and cancellation rate of COH)and pregnancy outcome(biochemical and clinical pregnancy rate,implantation rate,ectopic pregnancy rate,early abortion rate)of frozen embryo transfer by Feb.2021.Statistical analysis was performed by SPSS26.0 software.According to the type of distribution,the quantitative data were expressed as mean ±standard deviation(x±s)or median(the first quartile～the tired quartile)[M(P25～P75)].The intra-group comparison uses independent-samples T test or Mann-Whitney U test according to the type of data distribution.Pearson correlation or Spearman correlation was used in bivariate correlation.Binary logistic regression was used in variable regression analysis.The statistical results P<0.05 is considered to be statistically significant.Counting nformation was expressed as rate(%),The difference between groups were analyzed by chi-square test or Fisher’s Exact Test with two-sided test of hypothesis,and the statistical results P<0.05 is considered to be statistically significant.Result1.BMI in A1 group was significantly lower than that in A2 group(23,63±3.35,24.53±3.48,P<0.05),basal T level was higher in A1 group[0.40(0.28～0.57)vs.0.36(0.25-0.49),P<0.05],and AMH in A1 group was significantly higher than that in A2 group[8.65(5.97～11.97)vs.7.24(4.78～10.16),P<0.05].The BMI of group B1 was significantly lower than that of group B2(22.93±2.90 vs.24.57±3.51,P<0.05).The basal T level of group B1 was significantly higher than that of group B2[0.45(0.29～0.61)vs.0.36(0.26～0.50),P<0.05],and the AMH of group B1 was higher than that of group B2[10.57(6.34～13.10)vs.7.28(4.81～10.17),P<0.05].2.LH was negatively correlated with BMI(r=0.147),and positively correlated with basal T level(r=0.104)and AMH(r=0.190).LH/FSH was negatively correlated with BMI(r=0.121),but positively correlated with basal T level(r=0.142)and AMH(r=0.275).3.The using days and total dosage of Gn were less in group A1,and the difference was statistically significant[8.00(7.00～9.00)vs.9.00(8.00～10.00),1300.00(1050.005～1650.00)vs.1575.00(1250.005～1950.00),P<0.05];E2 level on HCG day in A1 group was significantly higher than that in A2 group[3625.00(2471.50～5909.50)vs.3165.50(2179.50-37.50),P<0.05].LH level on HCG day in group A1 was significantly higher than that in group A2[5.20(3.55～8.58)vs.2.91(1.89～4.79),P>0.05],but there was no significant difference between the two groups in P level and endometrial thickness on HCG day(P>0.05).The number of obtained oocytes in A1 group was higher than that in A2 group,and the difference was not statistically significant[18.00(10.75～25.00)vs.16.00(11.00～21.00),P>0.05].The rate of obtained oocytes in A1 group was significantly higher than that in A2 group(73.45%vs.66.28%).The using days and total dosage of Gn were significantly lower in group B1[8.00(7.00～9.00)vs.8.00(8.00～10.00),1200.00(1050.00～1500.00)vs.1575.00(1240.63～1950.00),P<0.05],and the total number of follicles on HCG day,the number and rate of obtained oocytes in B1 group were significantly higher[27.00(21.75～29.00)vs.23.00(17.00～30.00),18.00(11.00～26.00)vs.16.00(11.00～21.00),69.88%vs.67.59%,P<0.05].The level of E2,P and LH on HCG day in group B1 were also significantly higher than those in group B2[4226.00(3081.25～5985.25)vs.3123.00(2151.25～4734.75),0.58(0.40～0.97)vs.0.51(0.31～0.79),5.52(3.66～9.57)vs.3.08(1.93-0.17),P<0.05].4.The blastocyst rate in A1 group was significantly lower than that in A2 group(65.48%vs.68.76%P<0.05).There was no significant difference in 2PN fertilization rate(69.11%vs 68.90%),2PN cleavage rate(98.16%vs 98.03%),high quality embryo rate(72.87%vs 70.99%),retrieved oocytes freezing rate(83.22%vs 80.41%)and cancellation rate of COH(4.03%vs 3.47%)between A1 and A2 groups(P>0.05).The retrieved oocytes freezing rate and high quality embryo ratein group B1 was significantly higher than that in group B2(90.63%vs.79.37%,73.93%vs 70.94%,P<0.05).There was no significant difference in 2PN fertilization rate(69.29%vs 68.88%),2PN cleavage rate(97.65%vs 98.15%),blastocyst rate(67.63%vs 67.96%)and cancellation rate of COH(1.04%vs 4.05%)between B1 and B2 groups(P>0.05).5.There was no significant difference in biochemical pregnancy rate(78.81%vs.72.65%),clinical pregnancy rate(66.23%vs.64.09%),embryo implantation rate(56.25%vs.53.34%),ectopic pregnancy rate(1.00%vs.0.65%)and early abortion rate(13.00%vs.14.98%)between A1 and A2 groups(P>0.05).There was no significant difference in biochemical pregnancy rate(77.78%vs.73.37%),clinical pregnancy rate(63.89%vs.64.75%),embryo implantation rate(53.38%vs.54.18%),ectopic pregnancy rate(1.45%vs.0.59%)and early abortion rate(10.14%vs.15.38%)between B1 and B2 groups(P>0.05).Conclusion1.The level of LH and the ratio of LH/FSH in patients with PCOS were related to AMH,obesity and androgen level.LH level and LH/FSH ratio was positively correlated with AMH,androgen and negatively correlated with BMI.2.The ovaries of PCOS patients with elevated LH levels and LH/FSH ratio were more responsive to Gn,and the elevated basal LH had no adverse effect on the quality of oocytes.3.Elevated basal LH level and LH/FSH ratio did not have a negative effect on the treatment outcome of IVF-ET in patients with PCOS.Part Ⅱ Comparison of the effects of antagonist protocol and mild stimulation protocol on IVF-ET in PCOS patients with elevated LHObjectiveRetrospective analysis of IVF-ET treatment outcomes with antagonist protocol and mild stimulation protocol was made in PCOS patients with elevated basal LH,including basic characteristics,COH-cycle characteristics,laboratory characteristics and pregnancy outcomes,in order to provide clinical basis for more efficient and safe treatment of controlled ovarian hyperstimulation in this population.MethodA retrospective analysis was made of 149 cases of infertility PCOS patients with elevated basal LH,who underwent IVF/ICSI-ET treatment in Infertility Clinic Center,Qilu Hospital of Shandong University,from Jan.2018 to Dec.2020.According to the protocol they used in IVF/ICSI treatment,the patients were divided into two groups:group C1(n=129)with antagonist protocol and group C2(n=20)with mild stimulation protocol.Record and analyze the basic characteristics of patients(age,BMI,years of infertility,AMH,basal FSH,E2,P,T,TSH,PRL),COH-cycle characteristics(dosage and days of Gn,E2,LH,P levels on HCG day,endometrial thickness),laboratory characteristics(number and rate of obtained oocytes,2PN fertilization rate,2PN cleavage rate,high quality embryo rate,blastocyst rate,retrieved oocytes freezing rate and cancellation rate of COH)and pregnancy outcome(biochemical and clinical pregnancy rate,implantation rate,ectopic pregnancy rate,early abortion rate)of frozen embryo transfer by Feb.2021.Statistical analysis was performed by SPSS26.0 software.According to the type of distribution,the quantitative data were expressed as mean±standard deviation(x±s)or median(the first quartile-the tired quartile)[M(P25～P75)].The intra-group comparison uses independent-samples T test or Mann-Whitney U test according to the type of data distribution.Counting information was expressed as rate(%).The difference between groups were analyzed by chi-square test or Fisher’s Exact Test with two-sided test of hypothesis,and the statistical results P<0.05 is considered to be statistically significant.Result1.There was no significant difference in basic characteristics between the two groups(P>0.05).2.There was no significant difference in the using days of Gn between group Ci and C2(P>0.05).The dosage of Gn in group C2 was less than that in the antagonist group,but there was no significant difference between them[1312.50(1050.00～1668.75)vs.1150.00(1000.00-1631.25),P>0.05].There was no significant difference in E2 level and the number of oocytes on HCG day(P>0.05),but the level of LH and P on HCG day in group C1 was significantly lower than that in group C2[4.95(3.43～6.98)vs.10.46(8.20～15.58),0.56(0.32～0.83)vs.0.89(0.49-1.41),P<0.05].The endometrial thickness on HCG day in C2 group was significantly lower than that in C1[10.50(9.00～12.00)vs.9.00(8.00～10.00),P<0.05].There was no significant difference in number and rate of obtained oocytes between C1 and C2 groups.3.There was no significant difference in 2PN fertilization rate(69.40%vs.67.29%),2PN cleavage rate(98.19%vs.98.01%),blastocyst rate(65.05%vs.68.28%),retrieved oocytes freezing rate(81.40%vs.95.00%)and cancellation rate of COH(3.88%vs.5.00%)between the two groups(P>0.05).The high quality embryo rate of Ci group was significantly higher than that of C2 group,and the difference was statistically significant(76.03%vs.52.03%,P<0.05).4.There was no significant difference in biochemical pregnancy rate(78.63%vs.80.00%),clinical pregnancy rate(65.65%vs.70.00%),embryo implantation rate(56.98%vs.51.72%),ectopic pregnancy rate(1.16%vs.0.00%)and early abortion rate(11.63%vs.21.43%)between C1 and C2 groups(P>0.05).Conclusion1.When PCOS patients with elevated LH were underwent IVF-ET treatment with mild stimulation protocol,the rate of high quality embryo was lower than that with antagonist protocol,but there was no significant difference in 2PN fertilization rate,2PN cleavage rate and blastocyst rate.2.The treatment outcomes of IVF-ET with mild stimulation protocol and antagonist protocol had no significant difference in PCOS patients with elevated LH. |
