目的 探讨基础卵泡刺激素(bFSH)和基础黄体生成激素(bLH)比值对不孕患者行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)时临床结局的预测价值. 方法 回顾分析2008年1月1日至2008年12月31日在本生殖中心因输卵管阻塞、子宫内膜异位症、男方少弱精子和无精子症、不明原因不育等行IVF/ICSI-ET年龄≤40岁的超排患者2,167例(2,167周期).按bFSH值分为bFSH正常组(bFSH≤8.5 IU/L)及升高组(bFSH＞8.5 IU/L)；再按年龄分为≤29岁,30～34岁及35～40岁组.分析基础FSH/LH值在bFSH正常及升高两组不同年龄阶段患者在促性腺激素(Gn)刺激时间、Gn用量、获卵数及优质胚胎率,临床妊娠率、流产率、重度卵巢过度刺激综合征(OHSS)发生率的差异. 结果 Gn用量在年龄≤29岁患者无论bFSH水平是否升高,基础FSH/LH≤1者明显少于＞1者；获卵数在bFSH正常组患者中各年龄段基础FSH/LH≤1者明显多于＞1者,且在年龄＜35岁以前各组间随着基础FSH/LH升高获卵数明显减少；在bFSH升高组(bFSH＞8.5IU/L)患者中仅年龄30～34岁的患者基础FSH/LH≤1者获卵数明显多于＞1者,在其余各组随FSH/LH升高获卵数均有减少趋势；Gn刺激时间、优质胚胎率、临床妊娠率、流产率在bFSH正常及升高组各年龄段均无统计学意义.结论 基础FSH/LH值对指导选择合适的促排方案及Gn启动剂量有一定的指导意义.但不能仅凭借基础FSH/LH值预测IVF/ICSI临床结局.%Objective: To investigate the predictive significance of basal FSH/LH ratio on the outcomes of IVF/ ICSI in infertile couples.rnMethods: A total of 2,167 stimulating IVF/ICSI cycles from Jan. 2008 to Dec. 2008 were studied retrospectively. The infertile pathogeny included male factor, fallopian tube factor, endometriosis or unexplained infertility, whose average age was under 40. Based on bFSH level, all the patients and cycles were divided into following two groups, i. e. normal bFSH (bFSH≤8. 5IU/L) and elevated bFSH (bFSH >8. 5IU/L). Then each group, in turn, was divided into three subgroups according to age (≤29, 30-34 and 35-40 years old). Total dosage of gonadotrophins, duration of gonadotropin administration, number of oocytes retrieved, top quality embryo rate, clinical pregnancy rate, miscarriage rate and incidence of severe ovarian hyper-stimulation syndrome were analyzed among these subgroups. Results: The gonadotrophin dose used in women younger than 29 years old with FSH/LH ≤1 was significantly lower than that of women with FSH/LH ratio>1. Regardless of age, the number of retrieved oocytes was significantly more in the women with normal bFSH and FSH/LH≤1 than that of women with FSH/LH> 1. Moreover, patients in ages younger than 35 years old with higher FSH/LH ratio had significantly fewer number of retrieved oocytes than the patients with lower FSH/LH ratio. While for patients with elevated bFSH(bFSH>8. 5 IU/L) , this phenomenon can be only found in groups of age 30-34. And the same trend that the less retrieved oocytes was accompanied with elevated bFSH was also found in the other groups. There were no differences in the duration of gonadotropin administration, top quality embryo rate, clinical pregnancy rate and abortion rate in the women with same basal FSH and age.rnConclusion: The basal FSH/LH ratio may be a good predictor of ovarian response for selecting proper stimulation protocol and initiatory dosage. But the outcome of IVF/ICSI can not be predicted only by basal FSH/LH ratio.
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