hCG注射日雌二醇(E_2)增幅及每成熟卵泡E_2水平对控制性促排卵hCG扳机的影响

目的:探讨控制性促排卵(COS)hCG注射日雌二醇(E2)在hCG扳机时的作用。方法:接受长方案垂体降调节IVF/ICSI-ET助孕的不孕症患者1 811例,测量COS周期中E2水平,计算E2增幅E2增幅=(hCG注射日E2值-hCG注射前日E2值)/hCG注射前日E2值]。按照E2的增幅分为5组:A1组E2增幅≤-10%,A2组E2增幅为-9%~10%,A3组E2增幅为11%~50%,A4组E2增幅为51%~100%,A5组E2增幅100%;另按hCG注射日每卵泡E2水平分为5组:B1组E2≤200 pg/ml,B2组E2为201~300 pg/ml,B3组E2为301~400 pg/ml,B4组E2为401~500 pg/ml,B5组E2500 pg/ml。比较各组间一般临床特征及IVF-ET的临床结局。结果:①A1组hCG注射日直径≥14 mm卵泡数、获卵数及2PN数较其他4组高,hCG注射日直径≥18 mm卵泡比例,较其他4组低,差异均有统计学意义(P0.05),临床妊娠率偏低,但与其余4组间无统计学差异(P0.05);②A5组hCG注射日P水平、hCG注射日直径≥14 mm卵泡数、获卵数、2PN数、临床妊娠率和胚胎着床率均较其他4组低,差异有统计学意义(P0.05);③B2组临床妊娠率和胚胎着床率较其他4组高,差异有统计学意义(P0.05)。结论:hCG注射日E2增幅介于-9%~100%、每成熟卵泡E2值介于201~300 pg/ml之间是hCG扳机的最佳时机。

Value of Estradiol （E2） Increment and Serum E2/Follicles on the Day of hCG Administration in Predicting hCG Trigger in Controlled Ovarian Stimulation

Objective： To investigate the value of estradiol （E2） on the day of hCG administration in controlled ovarian stimulation（COS） of in vitro fertilization/intracytoplastic sperm injection-embryo transfer （IVF/ ICSI-ET）. Methods： A total of I 811 cycles of long protocol IVF/ICSI-ET were studied, the E2 increment on hCG administration day = （the E2 level on hCG administration day - the E2 level before the hCG administration day）/the E2 level before the hCG administration day. According to the E2 increment on hCG administration day, the patients were divided into 5 groups, group AI： E2 increment ≤ -10%, group A2：E2 increment -9%-10%, group A3： E2 increment 11%-50%, group A4：E2 increment 51%-100%, group A5： E2 increment〉100%; and according to the E2 level per mature follicle on hCG administrated day, these patients were divided into 5 groups, group B 1：E2 level per mature follicle was： ≤ 200 pg/ml, group B2： E21evel was 201-300 pg/ml, group B3： E21evel was 301-400 pg/ml, group B4：E2 level was 401-500 pg/ml, group B5： E2 level was 〉500 pg/ml. The general clinical charecteristics and clinical outcome of IVF/ICSI-ET were compared. Results： 1） The follicle （diameter≥ 14 mm） number on hCG administration day, oocyte retrieved number, 2PN number were significantly higher in group A1 than those in other 4 groups （P〈0.05）, the ratio of follicles with diameter ≥ 18 mm on hCG administration day was significantly lower in group A1 than that in other four groups （P〈0.05）. 2） The P level on hCG administration day, the follicle （diameter ≥ 14 mm） number on hCG administration day, oocyte retrieved number, 2PN number were significantly lower in group A5 than those in other 4 groups （P〈0.05）; both the clinical pregnancy rate and the embryo implantation rate were significantly lower in group A5 than those in groups A2, A3, A4 （P〈0.05）. 3） The clinical pregnancy rate and the embryo implantation rate were significantly higher in group B2 （E2 per mature follicle 200-300 pg/ml） than those in other 4 groups （P〈0.05）. Conclusion： It was the best time for hCG trigger when the E： increment was between -9% to 100% and serum E2 level per mature follicles was between 201 pg/ml to 300 pg/ml on the day ofhCG administration.