晚卵泡期及胚胎移植日血清雌激素比值与体外受精结局的关系

目的探讨控制性超促排卵(COH)周期中晚卵泡期及胚胎移植日雌激素比值与体外受精-胚胎移植(IVF-ET) 结局的关系。方法 180例不育症患者行COH,注射人(绒毛膜促性腺激素hCG)日及ET日测定血清雌激素水平,依其比值分为三组:组1:hCG日(雌二醇E2)／ET日E2<2．0;组2:比值介于2．0～4．0之间;组3:比值>4．0。结果 COH后共有58例妊娠(33．9％),妊娠组与非妊娠组及三组间比较,患者年龄、hCG日E2水平、获卵数、受精率、ET日E2水平均无显著差异,但当hCG日E2与ET日E2比值>4．0时,妊娠率显著降低。结论在IVF周期中,hCG日至ET日E2值迅速下降幅度可预测妊娠结局,推测雌激素水平迅速下降可能损害子宫内膜的容受性;黄体期适当地补充雌激素将有利于妊娠结局。

Ratio of estradiol concentration of late-follicular phase to that at the day of embryo transfer has a predictive value for in-vitro fertilization ontcome

Objective: To study the effect of serum estradiol (E2) ratio between late-follicular phase and the day of embryo transfer on pregnancy during controlled ovarian hyperstimulation (COH). Methods: In 180 infertility patients who underwent COH, serum estradiol was measured on the day of hCG administration (day-of-hCG) and the day of embryo transfer (day-of-ET). They were divided into three groups according to the ratio of day-of-hCG estradiol to day-of-ET estradiol: group one (<2. 0), group two (2. 0-4. 0), and group three (>4. 0). Results: A total of 58 pregnancies were noted (33. 9%). There were no significant differences in age, the level of day-of-hCG estradiol, the number of retrieved oocytes, the fertilization rates and the level of day-of-ET estradiol between pregnant and non-pregnant women and among the three groups. However, when the ratio of day-of-hCG estradiol to day-of-ET estradiol was more than 4. 0, the clinical pregnancy rate was significantly lower. Conclusion: Our study suggests that, in IVF cycle, the rapidly decline of the ratio of day-of-hCG estradiol to day-of-ET estradiol is important in predicting IVF success. We postulate that a dramatic drop in estradiol level may compromise the endometrial receptivity, and the proper supplementation of estradiol during luteal phase might be beneficial to improve some women's pregnant outcome.