黄体期个体化雌激素补充方案对IVF-ET治疗结局的影响

目的:探讨黄体期个体化添加不同剂量雌激素对体外受精-胚胎移植(IVF-ET)胚胎种植率和临床妊娠率的影响。方法:回顾性分析104个长方案控制性促排卵(COH)IVF-ET周期,根据其移植日血清E2水平下降幅度分为4组,A组:E2下降<30%,12个周期,单用黄体酮进行黄体期支持;B组:E2下降30%-39%,18个周期,黄体期支持采用黄体酮+3mg/d雌激素;C组:E2下降40%-49%,16个周期,D组:E2下降≥50%,58个周期,C组、D组患者黄体期支持采用黄体酮+4mg/d雌激素。结果:各组的取卵数目、受精率、卵裂率、优质胚胎数、内膜厚度和移植胚胎数相比差异均无显著性(P>0.05)。A组、B组、C组间胚胎种植率和临床妊娠率无统计学差异;而D组与其余3组比,胚胎种植率和临床妊娠率显著下降(P<0.05)。结论:①在长方案COH的IVF-ET中,当移植日血清E2水平下降幅度≥30%时黄体期支持补充雌激素可以改善胚胎种植率和临床妊娠率;②E2下降幅度大的患者可能需要增加雌激素的添加剂量。     

hCG注射日和取卵后48h雌激素下降幅度与体外受精-胚胎移植结局的关系

目的:探讨控制性超促排卵(COH)周期中注射hCG日与取卵(OPU)后48 h雌激素(E2)下降幅度与体外受精-胚胎移植(IVF-ET)结局的关系。方法:回顾性分析1 271个IVF/ICSI-ET助孕周期患者hCG注射日和OPU后48 h时血清E2水平,并根据血清E2下降幅度、年龄及助孕结局分组比较。结果:①E2下降幅度在未妊娠组、早期流产组和继续妊娠组间无统计学差异(P>0.05)。②hCG注射日与OPU后48 h E2下降幅度>80%时,胚胎着床率和临床妊娠率均明显下降(P<0.05),早期流产率无明显变化(P>0.05)。结论:hCG注射日与OPU后48 h E2下降>80%时,影响子宫内膜容受性,胚胎着床率及临床妊娠率下降,但不增加早期流产率。     

不同剂量黄体酮在体外受精-胚胎移植中黄体支持的效果

目的:探讨不同剂量黄体支持对IVF-ET周期黄体期雌、孕激素水平及临床结局的影响。方法:回顾分析长方案超促排卵IVF-ET305周期,根据hCG日雌激素水平采取4种不同黄体支持方案;对照组53例,hCG日血清E2值≤8000pmol/L,胚胎移植日开始肌注黄体酮60mg/d到验孕日。实验组:A组43例,hCG日血清E2值≤4000pmol/L,在取卵第2天开始肌注黄体酮20mg/d联合2000IU hCG q3d×4次到验孕日;B组115例,hCG日E24000pmol/L～8000pmol/L,取卵后第2天开始肌注40mg/d黄体酮到验孕日;C组94例,hCG日血清E2值≥8000pmol/L,取卵后第2天开始肌注60mg/d黄体酮到验孕日。结果:4组患者年龄、不孕年限、不孕因素、Gn用药天数、用药量、移植胚胎数均无明显差异(P0.05);4组hCG日雌激素水平、获卵数、ET日和种植窗期雌激素水平均有显著差异(P0.05),但4组ET日及种植窗期的E2/P值无显著差异;4组的种植率和妊娠率分别为27.68%、32.18%、32.54%、29.33%和41.51%、46.51%、50.43%、42.55%,无统计学差异。结论:不同剂量黄体支持有助于维持黄体期雌、孕激素平衡,有利于减少黄体酮剂量而不影响妊娠结局。     

IVF-ET后补充小剂量雌激素不改善妊娠率

目的:探讨体外受精-胚胎移植(IVF-ET)黄体支持中补充小剂量雌激素(E2)对妊娠率的影响。方法:①回顾性分析912个IVF-ET周期,根据黄体支持方案将其分为A组(511个周期),给予黄体酮80mg/d;B组(401个周期),给予黄体酮80mg/d+补佳乐2mg/d,比较组间妊娠率;②按照hCG日与ET日E2比值,分为<4.0组(291个周期)和≥4.0组(220个周期),比较二组妊娠率,了解E2下降程度与妊娠的关系;③另选择IVF超排卵妇女因某种因素未行移植(24个周期)和自然周期排卵妇女(32个周期)比较黄体中期E2水平,以了解超促排卵对黄体中期E2的影响。结果:黄体期补充与不补充E2组间种植率和妊娠率均无差异(P>0.05);E2下降程度不同的二组间种植率和妊娠率也无差异(P>0.05)。IVF超排妇女黄体中期E2水平明显高于自然周期妇女(P<0.01)。结论:取卵后E2水平下降不影响IVF结局,补充E2进行黄体支持不能改善IVF妊娠率。     

胚胎移植位置对体外受精-胚胎移植结局的影响

目的探讨体外受精-胚胎移植（IVF-ET）中,在B超引导下将胚胎移植到子宫腔内的不同位置对妊娠率及胚胎种植率的影响。方法回顾性分析接受IVF-ET治疗的98例输卵管因素不孕患者（共108个周期）的临床资料,根据胚胎移植位置的不同分为两组：A组,胚胎移植到距宫底≥5～〈10mm,共51例患者,56个周期;B组,胚胎移植到距宫底≥10～≤15mm,共47例患者,52个周期。比较两组患者的临床妊娠率、胚胎种植率、异位妊娠率、多胎妊娠率及流产率。结果A组56个周期中,有14个周期妊娠,临床妊娠率为25％,移植胚胎121个,种植17个,胚胎种植率为14％;B组52个周期中,有23个周期妊娠,临床妊娠率为44％,移植胚胎115个,种植28个,胚胎种植率为24％。B组临床妊娠率和胚胎种植率显著高于A组,两组分别比较,差异均有统计学意义（P〈0．05）。两组的多胎妊娠率、异位妊娠率和流产率分别比较,差异均无统计学意义（P〉0．05）。结论在IVF-ET中,胚胎移植位置的不同可影响临床妊娠率和胚胎种植率。     

体外受精-胚胎移植中胚胎形态和发育时期与受孕结果的相关性

目的 :观察胚胎形态和发育速度对体外受精 -胚胎移植 ( IVF-ET)治疗结果的影响。方法 :35 4对夫妇进行的 371个 IVF-ET治疗周期 ( ICSI177个周期 ,常规 IVF 194个周期 ) ,根据移植胚胎形态等级将 IVF-ET周期分为 A、B、C、D 4组 ;再根据移植胚胎中有无≥ 4-细胞期胚胎将 IVF-ET周期分为≥ 4-细胞期胚胎组和 <4-细胞期胚胎 2组 ,分析移植胚胎形态等级和卵裂期对胚胎种植率和临床妊娠率的影响。结果 :371个周期共移植 112 5个新鲜胚胎 ,四个形态等级胚胎组之间种植率 ( P=0 .0 12 )和妊娠率 ( P=0 .0 0 6)差别有显著性。两个卵裂期胚胎组之间种植率 ( P=0 .0 0 7)和妊娠率 ( P=0 .0 10 )有显著性差异。 L ogistic回归分析发现胚胎质量 (形态等级 P=0 .0 0 38,卵裂期 P=0 .0 0 45 )是影响临床妊娠结果的因素。结论 :移植胚胎的形态和发育期与胚胎种植率及临床妊娠率密切相关     

血清雌孕激素水平及其比值对体外受精-胚胎移植结局的影响

目的 探讨注射人绒毛膜促性腺激素(HCG)当天孕激素水平及雌孕激素比值对体外受精-胚胎移植(IVF-ET)妊娠率的影响.方法 2006年5月至2007年3月在贵阳市妇幼保健院生殖中心就诊279例不孕症患者300个周期进行IVF-ET治疗,在注射HCG当天测定雌二醇(E2)、孕酮(P).按注射HCG日所测血清P水平分为3组:第1组P≤2.86nmol/L 131周期;第2组2.86nmol/L9.54nmol/L 77周期.按P/E2比值分为2组:注射HCG日P/E2<1组219例.P/E2≥1组81例.结果 按P水平分组,第3组妊娠率(27.2%)明显低于其他2组(第1组52.6%,第2组45.6%),P<0.05.P/E2<1组妊娠率(49.8%)高于P/E2≥1组(28.4%),P<0.05.结论 在IVF-ET治疗中注射HCG当天血清P水平及P/E2比值影响妊娠结局,是预测IVF-ET妊娠率的较好指标.     

自然周期冻融胚胎移植日雌二醇水平对妊娠结局的影响

目的探讨冻融胚胎移植时自然周期内膜准备中胚胎移植日雌二醇(E2)水平对妊娠结局的影响。方法选择2010年9月至2011年10月在沈阳市妇婴医院生殖中心进行冻融胚胎移植周期中,以自然周期进行内膜准备的患者110例,进行130个周期冻融胚胎移植。按移植日雌二醇水平分为4组:A组:E2≤183.5pmol/L14周期;B组:E2>183.5pmol/L,≤367.0pmol/L34周期;C组:E2>367.0pmol/L,≤734.0pmol/L74周期;D组:E2>734.0pmol/L8周期。对各组的年龄、子宫内膜厚度、移植胚胎数、临床妊娠率、胚胎种植率及流产率进行比较。结果各组年龄、子宫内膜厚度、移植胚胎数及流产率比较差异均无统计学意义。C组临床妊娠率和种植率分别为62.2%和30.9%,明显高于A组(42.9%,23.5%)和B组(52.9%,28.6%),P<0.05。B组临床妊娠率和种植率与A组比较有增高趋势,但差异无统计学意义,P>0.05。D组临床妊娠率为25.0%(2/8),胚胎种植率为10.0%(2/20)。D组因例数较少未进行统计学比较。结论在冻融胚胎移植周期中,以自然周期进行内膜准备时,胚胎移植日雌二醇水平过低或过高都影响临床妊娠率及胚胎种植率。     

体外受精-胚胎移植周期中血清性激素水平对胚胎着床的影响

目的探讨IVF周期中血清雌、孕激素水平及其比值与胚胎着床关系。方法行IVF-ET治疗38例患者共38个周期（其中妊娠组17例、未孕组21例）,用化学发光法测定HCG日、胚胎移植日、胚胎种植窗血清孕酮、雌二醇水平;统计学方法t检验。结果两组黄体支持黄体酮剂量差异无统计学意义（P〉0.05）,妊娠组与未孕组HCG日、胚胎移植日、种植窗血清雌、孕激素水平升降变化趋势一致,但妊娠组以上三个时期雌二醇水平高于未孕组,但差异无统计学意义（P〉0.05）,种植窗孕酮高于未孕组（P〈0.05）;妊娠组种植窗与移植日E2/P值明显低于未孕组,差异无统计学意义（P〉0.05）。结论IVF-ET周期患者自身黄体功能影响妊娠结局,血清E2/P比值过高可能影响胚胎着床。     

不同黄体支持方法对体外受精-胚胎移植结果的影响

目的:探讨三种黄体支持方法对体外受精-胚胎移植(IVF-ET)结果的影响。方法:回顾性分析195个IVF-ET周期的结果,根据注射hCG当天的血E2水平、B超示直径≥14 mm卵泡数目及所用的黄体支持方法分组。A组:112例,E2<2 000 pg/mL,直径≥14 mm的卵泡数<10个,hCG进行黄体支持;对E2≥2 000 pg/mL,卵泡数目≥10个者,随机分为两组,B组,46例,单用黄体酮进行黄体支持;C组,37例,黄体酮加雌激素进行黄体支持。结果: 三组间妊娠率、种植率、流产率、OHSS发生率差异均无显著性,P>0.05。结论:hCG用于IVF黄体支持并不优于黄体酮,但在一定程度上可避免某些患者由于注射黄体酮产生的痛苦。黄体酮+雌激素进行黄体支持应该是黄体支持较合理的方案,还需进一步研究。     

短方案降调节hCG注射日前后血清雌孕激素水平变化及其比值对IVF/ICSI结局的影响

目的:探讨体外受精-胚胎移植(IVF-ET)中hCG注射日前后血清雌孕激素水平变化及其比值对妊娠结局的影响。方法:选取行短方案治疗的137例不孕症患者的临床资料,根据hCG注射日每成熟卵泡(B超下直径≥14 mm的卵泡)的E2水平分为3组,A1组E2水平<450 pg/ml,A2组E2水平450~600 pg/ml,A3组E2水平>600 pg/ml;据hCG注射日较前一日E2增幅程度不同亦分为3组,B1组增幅程度<20%,B2组增幅程度20%~30%,B3组增幅程度>30%;另外为探讨hCG注射日雌、孕激素比值对妊娠结局的影响,按hCG注射日E2/P值不同亦分为3组,C1组E2/P<3,C2组E2/P=3~5,C3组E2/P>5;对上述3组的临床资料进行回顾性分析。结果:A2组的临床妊娠率高于A3组,A1和A2组的胚胎种植率亦高于A3组,差异均有统计学意义(P<0.05);B1组的临床妊娠率明显高于B2和B3组,B1组的胚胎种植率亦高于B3组,差异均有统计学意义(P<0.05);C3组的临床妊娠率高于C1组,差异有统计学意义(P<0.05);C2、C3组的胚胎种植率明显高于C1组,差异有统计学意义(P<0.05)。结论:行IVF-ET患者的hCG注射日前后适合水平的血清雌、孕激素及其比值(E2水平在450~600 pg/ml,hCG注射日前后E2增幅<20%及E2/P>5)能获得较好的妊娠结局。     

Relationship between peak serum estradiol levels and treatment outcome in in vitro fertilization cycles after embryo transfer on day 3 or day 5

OBJECTIVE: To examine the relationships between peak serum estradiol (E(2)) levels and treatment outcome in in vitro fertilization (IVF) cycles after embryo transfer (ET) on day 3 or day 5. DESIGN: Retrospective analysis of 697 IVF-ET cycles between January 1999 and December 2001. SETTING: A university-affiliated assisted reproduction program. PATIENT(S): Infertile patients undergoing IVF-ET cycles. INTERVENTION(S): Peak E(2) concentration in serum was determined on the day of human chorionic gonadotropin (hCG) administration. The IVF-generated embryos were cultured for 2 days until transfer on day 3. If more than four 8-cell embryos were present on day 3, embryo culture was continued until day 5 for blastocyst transfer. MAIN OUTCOME MEASURE(S): Clinical pregnancy rates. RESULT(S): High peak E(2) levels did not adversely affect treatment outcome. After the cycles were divided according to the day of ET, high peak E(2) levels were associated with improved pregnancy rates after ET on day 5 but not on day 3. CONCLUSION(S): Increasing peak E(2) levels in IVF cycles are associated with improved pregnancy rates after ET on day 5.     

Serum human chorionic gonadotropin measured 7 days following day 3 embryo transfer might predict pregnancy outcome in IVF

This prospective study investigated the predictive value of pregnancy outcomes with serum human chorionic gonadotropin (hCG) 7 days after day 3 embryo transfer (D3 ET), and whether estradiol (E2) and progesterone (P) improved the diagnostic efficiency. The study comprised 280 in vitro fertilization and embryo transfer (IVF-ET) cycles. Serum samples were obtained 7 days after D3 ET to measure hCG, E2, and P concentrations. Statistical analyses were conducted to evaluate the predictive value for pregnancy outcomes. We found significant differences in hCG level between pregnancy and non-pregnancy, viable and non-viable pregnancy, biochemical and viable pregnancy, as well as singleton and multiple pregnancy. An hCG cutoff value of 2.5?mIU/mL is predictive of pregnancy with a positive predictive value (PPV) of 95.9% and a negative predictive value (NPV) of 92.4%. An hCG value of 10.8?mIU/mL is predictive of a multiple pregnancy with an NPV of 98.1%. The area under the hCG curve between pregnancy and non-pregnancy was not improved by adding E2, P, or combined E2/P. Our results suggest a predictive value of pregnancy outcome with serum hCG drawn 7 days after D3 ET in IVF, and the diagnostic accuracy is not improved by adding measurements of E2/P.     

Serum oxytocin profiles in patients with repeated implantation failure during IVF cycles

Abstract

Objective: The objective of this study is to investigate the association between oxytocin (OT) levels and repeated implantation failure (RIF) during in vitro fertilization-embryo transfer (IVF-ET) cycles.

Methods: Blood samples were collected from 108 women undergoing IVF-ET treatment at the following time points: gonadotrophin (Gn) administration day (Gn Day 0), hCG administration day (hCG Day 0), ET administration day (ET Day 0), and 5?d after ET (ET Day 5). Serum OT and steroid profiles were measured and compared among three groups: Group A included 38 women with a history of RIF, Group B included 41 women who became pregnant following the first fresh ET, and Group C included 29 women who did not become pregnant following the first fresh ET.

Results: The OT levels of the three groups at different time points were not significantly different. Serum OT levels were significantly higher on hCG Day 0, ET Day 0, and ET Day 5 than on Gn Day 0, and they were significantly correlated with the estradiol concentration on ET Day 0.

Conclusions: RIF patients do not have elevated serum OT levels during IVF-ET cycles.     

多囊卵巢综合征患者hCG注射日血清睾酮水平对IVF-ET结局的影响

目的:探讨多囊卵巢综合征患者hCG注射日血清睾酮(T)水平对IVF-ET结局的影响。方法:因顽固性排卵障碍而行IVF助孕的187例PCOS患者,于促排卵前均口服短效避孕药预治疗3￣6个月,T降至正常水平后,采用GnRHa长方案,观察比较妊娠组和非妊娠组hCG注射日血清T水平、获卵数、受精率、优质胚胎率。结果:非妊娠组T水平明显高于妊娠组,受精率及优质胚胎率均低于妊娠组,差异有统计学意义。结论:PCOS患者促排卵过程中T明显升高,可能对卵子质量及妊娠结局产生不良影响。     

Luteal phase hormonal profile in prediction of pregnancy outcome after assisted reproduction

The clinical efficacy of luteal phase hormones including estradiol and progesterone in the prediction of pregnancy and its outcome in ICSI-ET cycles was evaluated. In 121 ICSI-ET cycles, serial estradiol and progesterone levels were measured in the luteal phase. The day of ovum pick-up was designated as day 0. All the patients had luteal support with vaginal progesterone suppositories after embryo transfer (ET). Serial estradiol measurements were performed on days 8, 11 and 13 and progesterone level on day 11. A single dose of hCG was given for corpus luteum rescue 5000 IU, if day 8 estradiol level <200pg/ml; 2000IU, if estradiol between 200 and 800pg/ml; no hCG if estradiol level >800pg/ml). On day 15, beta-hCG level was measured to detect pregnancy and if positive, injected on day 17. Fifty-seven pregnancies were achieved in 121 cases after ET (47%). Clinical pregnancy rate and ongoing pregnancy rate per ET were 37.1 and 30%, respectively. While there was no difference between progesterone levels measured on day 11, estradiol levels on days 11 and 13 were significantly higher in women who became pregnant. In 40 patients taking only progesterone and in 81 cases taking hCG plus progesterone, estradiol levels on days 11 and 13 were significantly higher in women who became pregnant. Progesterone levels on day 11, in progesterone treated groups, did not differ between pregnant and non-pregnant patients. Estradiol and progesterone levels on day 11 and estradiol levels on day 13 showed a big overlap between pregnant and non-pregnant patients. The efficacy of serial testing was evaluated. An increase in estradiol level from day 11 to 13 was associated with 71% pregnancy rate (72% ongoing). In the case of a decrease in estradiol level, the pregnancy rate was 18% of which 80% had to implant. Rising estradiol in the late luteal phase is associated with higher pregnancy rate and more successful pregnancy outcome.     

Effects of low-dose human chorionic gonadotropin on corpus luteum function after embryo transfer

This paper reports the effect of low-dose human chorionic gonadotropin (hCG) on the levels of serum hCG, progesterone, and estradiol, luteal-phase length, and conception in 20 patients undergoing in vitro fertilization and embryo transfer (IVF-ET). Alternate patients in a group of 20 received 1000 IU hCG on the day of embryo transfer and 3 days after. Six and 9 days from embryo transfer 2000 IU hCG was given. The remaining patients served as controls. No patients in the treated group and four in the control group became pregnant. The endocrine profiles with respect to hCG, progesterone, and estradiol levels were similar in the treated patients compared with pregnant patients in the control group. Treated patients had significantly longer (18.0±1.1 days) luteal phases compared with nonpregnant patients in the control group (12.5±1.2 days), indicating that low-dose hCG prolonged the life of the corpus luteum. It was concluded that while the administration of low-dose hCG prolonged the life of the corpus luteum, it did not apparently improve the conception rate.     

A modest increase in serum progesterone levels on the day of human chorionic gonadotropin (hCG administration may influence pregnancy rate and pregnancy loss in in vitro fertilization-embryo transfer (IVF-ET) patients

Purpose Our purpose was to study the effect of a modest increase in preovulatory serum progesterone (P₄) levels in hyperstimulated patients and its association with pregnancy rate and pregnancy loss following in vitro fertilization (IVF) and embryo transfer (ET).Patients Only patients with mechanical factor and three transferred embryos were included in the present study. They were divided into two groups according to two critical breakpoints for P₄ serum levels on the day of hCG administration: serum P₄ below 0.6 ng/ml in 28 cycles (group I) and >0.6 ng/ml in 80 cycles (group II).Setting The setting was the IVF program at Carmel Medical Center, Haifa, Israel.Results The pregnancy rate per embryo transfer was 53% (15/28) in group I and 10% (8/80) in group II (P < 0.025). Of 15 pregnancies achieved in group I, 14 were ongoing pregnancies, compared to 4 of 8 ongoing pregnancies in group II (P <0.03). Conclusions Our findings suggest that a very modest increase in serum P₄ levels on the day of hCG administration is associated with lower pregnancy and ongoing pregnancy rates in IVF-ET.