不同促卵子成熟hCG用量对IVF-ET妊娠结局的影响

目的：探讨减少人绒毛膜促性腺激素（hCG）用量预防卵巢过度刺激综合征（OHSS）的可行性及安全性。方法：选择2009年1月—2011年12月进行体外受精-胚胎移植（IVF-ET）且发育卵泡数≥14个、hCG日雌二醇（E2）水平≥10 000 ng/L的OHSS高危患者327例，依据hCG用量不同分为2组：204例hCG 2 000～4 000 IU者为A组；123例hCG 10 000 IU者为B组，比较2组超促排卵（COH）情况、卵子成熟度、胚胎质量、妊娠结局以及OHSS发生率是否存在差异。结果：A、B组年龄、体质量指数（ＢＭＩ）、促性腺激素（Gn）起始剂量、COH时间及Gn总量差异无统计学意义，A、B组hCG日E2水平、发育卵泡数、获卵数、受精方式、受精率、两原核（2PN）胚胎数、优质胚胎数、移植胚胎（ET）数、冷冻胚胎数、全胚胎冻存数差异无统计学意义。2组移植周期临床妊娠率差异无统计学意义；A组重度、极重度OHSS发生率明显低于B组。结论：在IVF-ET过程中，对于OHSS高危患者，减少促卵子成熟的hCG用量对卵子的成熟、受精、胚胎质量以及移植周期临床妊娠率无明显的影响，可以有效降低重度和极重度OHSS的发生，是一种有效预防重度、极重度OHSS的方法。

Effect of hCG at Different Dosages on the Pregnancy Outcomes of IVF-ET

Objective： To investigate the effects of hCG at different dosages on embryo quality and IVF-ET outcomes，so as to discuss the feasibility and safety of the lowered dosage of hCG in inducing ovulation to prevent OHSS. Methods：327 patients who had high risks of OHSS were divided into two groups as follows，group A：204 patients with hCG dosage of 2 000-4 000 IU；group B：123 patients with hCG dosage of 10 000 IU. Age，initial Gn dosage，total dosage of Gn，No. of egg retrieval，clinical pregnancy rate and the OHSS rate，were compared between two groups. Results：There were no significant differences in age，BMI，initial and total dosage of Gn，days for COH between group A and B. The differences of the E2 levels on hCG injection day，No. of growth follicles，No. of egg retrieval，fertilization rates，2PN embryos，gradeⅠembryos，No. of ET and frozen embryo between two groups were statistically insignificant. The rate of severe OHSS in group A was lower than that in group B. The clinical pregnancy rate per egg retrieval cycle in group A was significantly lower than that in group B，while the differences of the pregnancy rates per transfer cycle between two groups were statistically insignificant. Ｃｏｎｃｌｕｓｉｏｎs： The decreasing dosage of hCG for ovulation induction in high risk OHSS patients during IVF-ET has no negative influence for egg maturation，insermination and embryo quality，but can effectively prevent the severe OHSS.