胚胎移植日血清雌激素下降幅度对体外受精-胚胎移植结局的影响

目的:探讨黄体期雌激素下降幅度对IVF-ET后胚胎种植率和临床妊娠率的影响。方法:回顾性分析97个接受长方案控制性超排卵及IVF-ET治疗周期分别测定其hCG日和ET日血清E2水平,根据其下降幅度分为6组。A组:12个治疗周期,E2下降幅度<20%;B组:13个治疗周期,E2下降幅度20%-29%;C组:11个治疗周期,E2下降幅度30%-39%;D组:16个治疗周期,E2下降幅度40%-49%;E组:24个治疗周期,E2下降幅度50%-59%;F组:21个治疗周期,E2下降幅度≥60%。结果:ET日E2水平呈不同程度的下降,当下降幅度≥30%时胚胎种植率和妊娠率明显降低,差异出现显著性(P<0.05)。结论:长方案COH及IVF-EF中,ET日E2水平下降幅度≥30%时会引起胚胎种植率和临床妊娠率的降低,应考虑给予雌激素的补充。     

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。     

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。     

黄体期添加不同剂量雌激素对IVF-ET妊娠结局的影响

目的:探讨长方案控制性超促排卵体外受精-胚胎移植(IVF-ET)周期黄体期减少外源性雌激素剂量对妊娠结局的影响。方法:回顾性分析2011年7月至2012年4月1614个长方案控制性促排卵周期的资料。根据黄体期补充补佳乐剂量不同分为2组:A组(785例)补佳乐2mg/d;B组(829例)补佳乐4mg/d。两组黄体支持期所用孕激素剂型、剂量相同。结果:两组间的临床特征、超排卵情况(COH)、胚胎形成情况均无统计学差异(P>0.05);添加补佳乐2mg/d组与4mg/d组的临床妊娠率(49.81%vs 49.88%)、胚胎种植率(34.25%vs 34.93%)及流产率(9.21%vs 10.92%)均无统计学差异(P>0.05)。结论:长方案IVF-ET周期黄体支持常规添加不同剂量雌激素助孕结果无显著差异,减少雌激素用量不影响妊娠结局。     

移植8cell胚胎个数与妊娠率的关系

目的:探讨体外受精-胚胎移植(IVF-ET)周期中第三天移植8cell胚胎数量与临床结局的关系。方法:以2009年1月至2010年12月在本中心接受IVF-ET治疗625个周期为研究对象。将所有移植周期按移植8cell胚胎个数分为三组,分析三组的临床妊娠率、胚胎种植率、多胎率有无差异。结果:移植两个8细胞胚胎组(C组)的临床妊娠率(59.5%)显著高于无8细胞胚胎移植组(A组)和含一个8细胞组(B组)(P<0.05),A、B两组临床妊娠率无显著性差异;C组种植率(39.8%)显著高于其他两组,A组和移植胚胎中含一个8细胞组(B组)种植率比较有显著性差异,;多胎率分析,C组明显高于其他两组。结论:在IVF-ET周期中第3天移植8cell胚胎个数对妊娠率及种植率、多胎率有影响,在挑选胚胎时移植一个8cell胚胎搭配一个其他细胞数的胚胎也能得到较好的妊娠率并有效降低多胎率。     

移植8cell胚胎个数与妊娠率的关系

目的:探讨体外受精-胚胎移植(IVF-ET)周期中第三天移植8cell胚胎数量与临床结局的关系。方法:以2009年1月至2010年12月在本中心接受IVF-ET治疗625个周期为研究对象。将所有移植周期按移植8cell胚胎个数分为三组,分析三组的临床妊娠率、胚胎种植率、多胎率有无差异。结果:移植两个8细胞胚胎组(C组)的临床妊娠率(59.5%)显著高于无8细胞胚胎移植组(A组)和含一个8细胞组(B组)(P<0.05),A、B两组临床妊娠率无显著性差异;C组种植率(39.8%)显著高于其他两组,A组和移植胚胎中含一个8细胞组(B组)种植率比较有显著性差异,;多胎率分析,C组明显高于其他两组。结论:在IVF-ET周期中第3天移植8cell胚胎个数对妊娠率及种植率、多胎率有影响,在挑选胚胎时移植一个8cell胚胎搭配一个其他细胞数的胚胎也能得到较好的妊娠率并有效降低多胎率。     

不同胚胎选择体系对IVF-ET妊娠结局的影响

目的:探讨IVF-ET周期中不同胚胎选择体系对妊娠结局的影响。方法:将530个IVF-ET周期随机分为3组,按不同的胚胎选择方法选择胚胎进行移植。A组:228个移植周期,根据d3胚胎常规评分方法选择胚胎;B组:140个移植周期,根据d3胚胎常规评分结合原核评分选择胚胎;C组:162个移植周期,根据d3胚胎常规评分结合胚胎早期分裂选择胚胎。将C组进一步分为移植胚胎中有早裂胚胎和无早裂胚胎二组。比较各组的临床妊娠率和单胚着床率。结果:B组的临床妊娠率和单胚种植率为37.86%和21.77%,与A组(33.33%和20.56%)比均无统计学差异(P>0.05);而C组(45.06%和30.88%)均显著高于A组(P<0.05);C组移植胚胎中有早裂胚胎者的临床妊娠率和单胚着床率为55.68%和38.38%,分别显著高于移植胚胎中不含早裂胚胎者(32.43%和21.94%)(P<0.05)。结论:d3胚胎常规评分结合胚胎早期分裂选择的胚胎移植,可以提高IVF-ET周期的临床妊娠率和单胚着床率。     

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。     

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。     

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。     

体外受精-胚胎移植周期中黄体期血清性激素水平与妊娠率的关系

目的探讨体外受精－胚胎移植（ＩＶＦ－ＥＴ）周期中黄体期血清性激素水平的变化及与妊娠率的关系。方法随机选取６２个采用卵泡刺激素／绝经期促性腺激素／绒毛膜促性腺激素（ＦＳＨ／ｈＭＧ／ｈＣＧ）促超排卵的ＩＶＦ－ＥＴ周期（６２例患者）,采用放射免疫测定技术,测定其自然周期与促超排卵周期中黄体期血清雌二醇（Ｅ２）、孕酮（Ｐ）、催乳素（ＰＲＬ）水平,观察其妊娠情况。结果促超排卵周期中黄体期血清性激素水平明显高于自然周期（Ｐ＜０．０５）。补充黄体酮者的Ｐ、Ｐ／Ｅ２值,明显高于未补充黄体酮者（Ｐ＜０．０５）。临床妊娠者的Ｅ２水平明显低于未妊娠者,而Ｐ／Ｅ２、ＰＲＬ值明显高于未妊娠者（Ｐ＜０．０５）,并且当Ｐ／Ｅ２值为３００～４００、ＰＲＬ值为６０～１００μｇ／Ｌ时妊娠率最高。结论ＩＶＦ－ＥＴ周期中黄体期血清性激素水平对妊娠有影响,其中Ｅ２、Ｐ协同发挥作用,ＰＲＬ在一定范围内有利于胚胎着床。在ＩＶＦ－ＥＴ中应适当补充黄体酮,调节性激素至最适水平,可提高临床妊娠率     

Oral oestradiol supplementation as luteal support in IVF/ICSI cycles: a prospective,randomized controlled study

Objective

To explore whether oral oestradiol (E2) supplementation (6 mg) in the luteal phase is beneficial to the outcome of patients undergoing gonadotrophin-releasing hormone agonist (GnRHa) long protocol in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles.

Study design

Prospective, randomized, controlled study at the IVF Clinic, Sun Yat-sen Memorial Hospital. In total, 402 patients with an indication for IVF or ICSI were recruited. Patients were prospectively randomized to receive either progesterone injection plus oral E2 supplementation (Group A, n = 202) or progesterone injection alone (Group B, n = 200) as luteal support after oocyte retrieval. The main outcome measure was the clinical pregnancy rate.

Results

No significant difference in the clinical pregnancy rate or miscarriage rate was observed between Group A and Group B (50.9% vs 58.0%, 14.6% vs 11.2%; p > 0.05). In different age subgroups (≤35 years and >35 years) all measurements were comparable in patients with or without E2 supplementation, as well as in subgroups with different E2 levels on the day of human chorionic gonadotrophin injection (E2 ≥ 3000 pg/ml and E2 < 3000 pg/ml).

Conclusion

Adding E2 as luteal support did not increase the clinical pregnancy rate or reduce the miscarriage rate. Routine use of a combination of E2 and progesterone as luteal support in GnRHa long protocol IVF/ICSI cycles is not recommended.     

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.     

Luteal phase support for patients undergoing frozen-thawed embryo transfer cycles--the required progesterone dose

OBJECTIVE: With the recent trend toward single-embryo transfer (ET), cryopreservation of extraneous embryos is becoming increasingly prevalent. Several replacement protocols for frozen-thawed ET exist, with no consensus regarding the dosage or delivery mode of progesterone. PATIENTS AND METHODS: Hormonal replacement with only estrogen and progesterone is the most frequently used protocol in women with and without functioning ovaries in our unit. Since August 2005, we have doubled the usual daily dose of progesterone for luteal support due to a high prevalence of patients experiencing withdrawal bleeding 11-13 days after ET. We compared the outcome of frozen-thawed ET cycles using different doses of progesterone for luteal support. RESULTS: While the prevalence of embryos that survived the thawing process was significantly higher in the earlier (69%) as compared to the later period (58%), positive b-hCG pregnancy rates (17.5% vs 44.8%, respectively) and clinical pregnancy rates per transfer (7.9% vs 41.4%, respectively) were significantly higher in the later period. CONCLUSION: We conclude that high-dose progesterone supplementation in the luteal phase of frozen-thawed ET cycles results in a significantly higher clinical pregnancy rate.     

Low serum estradiol concentrations after five days of controlled ovarian hyperstimulation for in vitro fertilization are associated with poor outcome

OBJECTIVE: To evaluate the prognostic significance of low serum E2 concentrations in controlled ovarian hyperstimulation (COH) cycles for IVF. DESIGN: Retrospective study. SETTING: Assisted conception unit of a university hospital. PATIENT(S): One thousand four hundred and forty patients undergoing COH for IVF. INTERVENTION(S): COH, serum E2 measurement, ultrasonographic scanning of ovarian follicles, oocyte retrieval, and ET. MAIN OUTCOME MEASURE(S): Cancellation and pregnancy rates. RESULT(S): Patients were classified into four groups according to serum E2 levels on the sixth day of COH: group A (E2 level < 50 pg/mL [114 cycles]), group B (E2 level 51-100 pg/mL [189 cycles]), group C (E2 level 101-200 pg/mL [320 cycles]), and group D (E2 level >200 pg/mL [817 cycles]). Group A experienced the highest cancellation rates (65.1%) and lowest pregnancy rates (7.8%) despite requiring significantly more hMG ampules (47.8+/-1.7). The cancellation rate was higher (75.1%) and no pregnancy occurred in a subset of group A in whom COH was initiated with > or =3 ampules (225 IU) of gonadotropins. CONCLUSION(S): In COH cycles using luteal phase buserelin, low initial serum E2 concentrations are associated with poor outcome.     

Luteal phase support with estrogen in addition to progesterone increases pregnancy rates in in vitro fertilization cycles with poor response to gonadotropins

In this study, our objective was to determine the effect of adding estradiol hemihydrate (E₂) to progestin (P) for luteal phase support on pregnancy outcome in in vitro fertilization (IVF) cycles with poor response to gonadotropins. Ninety-five women with poor ovarian response who underwent controlled ovarian hyperstimulation (COH) with gonadotropin releasing hormone (GnRH) agonist or GnRH antagonist plus gonadotropin protocol for IVF were prospectively randomized into three groups of luteal phase support after oocyte retrieval. Group 1 (n?=?33) received only intravaginal progesterone gel (Crinone 8% gel). Group 2 (n?=?27) and Group 3 (n?=?35) received intravaginal progesterone plus oral 2 and 6?mg estradiol hemihydrate, respectively. Main outcome measures were overall and clinical pregnancy rates (PRs) per patient. Serum LH, E₂ and P levels at 7th and 14th days of luteal phase were also measured. Overall and clinical PRs were significantly higher in 2?mg E₂?+?P than P-only group (44% versus 18% and 37% versus 12.1%, respectively). There were no statistically significant differences between 6?mg E₂?+?P versus P-only and 2?mg E₂?+?P versus 6?mg E₂?+?P groups regarding PRs. Addition of 2?mg/day E₂ in addition to P for luteal support significantly increase overall and clinical PRs in cycles with poor response to gonadotropins after IVF.