控制性超排卵中卵巢高反应对体外受精-胚胎移植/卵胞浆内单精子注射周期妊娠结局的影响

目的研究体外受精-胚胎移植/卵胞浆内单精子注射(IVF/ICSI)周期控制性超排卵(COH)中卵巢高反应对妊娠结局的影响。方法回顾性分析本生殖中心2003年1月至2005年12月的IVF/ICSI周期临床资料,根据雌二醇(E2)峰值百分位数确定卵巢反应,分为P25~75(E24,302~10,791 pmol/L),530个周期,定义为正常反应组(A组),E2水平在P75~90(E210,792~14,669 pmol/L)159个周期,为中度高反应组(B组),P90以上(E2≥14,670 pmol/L),105个周期为高反应组(C组),比较各组妊娠结局。结果与A组相比,B和C组获卵数显著增多(P<0.01),但卵母细胞质量和临床妊娠率无显著差异(P>0.05)。C组着床率(21.4%)显著低于A组(29.7%)(P<0.05),3组早期流产率无显著差异(P>0.05)。结论COH中卵巢高反应对胚胎质量无显著影响,但着床率降低,提示高雌激素环境影响子宫内膜容受性。

Pregnancy outcome in hyper-responders during controlled ovarian hyperstimulation in IVF / ICSI cycles

Objective: To evaluate the pregnancy outcome in hyper-responders during controlled ovarian hyperstimulation with GnRH agonist and rFSH in IVF/ICSI cycles.Methods: This retrospective study included 1,058 IVF/ICSI cycles performed from January 2003 to December 2005 in our reproductive center.Ovarian responses were grouped according to the percentile E_2 on the day of hCG administration.Group A consisted of normal responders defined as women with oestradiol concentrations between the 25th and 75th percentiles(4,302-10,791 pmol/L,530 cycles),group B consisted of moderately high responders,defined as women with oestradiol concentrations between the 75th and 90th percentile(10,792-14,669 pmol/L,159 cycles).Group C was set the cut-off concentration for hyper-responders as the 90th percentile and above(≥14,670 pmol/L,105 cycles). The pregnancy outcomes among three groups were analyzed with ANVOA and chi-square test.Results: The numbers of follicles,oocytes and fertilized embryos were significantly different in three groups(P<0.05),but there were no differences in oocyte retrieval rate,fertilization rate and high-grade embryo rate.Pregnancy rate was lower but with no significantly difference in hyperresponders' group(P>0.05).Implantation rate in group C was lower than that in normal responders(21.38% vs.29.74%,P<0.05).There were no difference in miscarriage rate during the first trimester among three groups(P>0.05).Women with moderate and severe ovarian hyperstimulation increased with the E_2 levels(P<0.05). Conclusions: The results suggest that hyper-response to the controlled ovarian hyperstimulation would not affect the oocyte quality and pregnancy rate,but significantly affect the implantation rate.High oestradiol concentrations during ovarian stimulation might expose the embryos to a sub-optimal endometrial environment.