黄体期补充雌激素对体外受精-胚胎移植的影响

目的探讨黄体期个体化补充雌激素(E2)对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法回顾性分析449个长方案控制性促排卵(COH)IVF-ET周期,根据其移植日E2下降水平分为3组,A组:29个周期,E2下降率≤30%,单用孕激素黄体支持;B组:186个周期,E2下降率30%⁵0%,分为对照组113个周期单用孕激素黄体支持,试验组73个周期给予孕激素+雌激素2mg黄体支持;C组:234个周期,E2下降率≥50%,分为对照组124个周期单用孕激素黄体支持,试验组110个周期给予孕激素+雌激素4 mg黄体支持。结果各组年龄、不孕年限、获卵数、受精率、卵裂率及移植日胚胎数均无统计学差异(P>0.05);A组与B组(对照组)、C组(对照组)妊娠率比较差异有统计学意义(P<0.05);补充E2组其临床妊娠率均高于对照组(P<0.05)。结论移植日E2下降率较大时可影响妊娠结局,黄体期根据E2下降率选择性补充雌激素可改善子宫内膜容受性,提高临床妊娠率。

Effects of estradiol supplementation on pregnancy outcomes during luteal phase in in vitro fertilization-embry-onic transfer cycles

Objective To evaluate the influence of estradiol supplementation on pregnancy outcomes during the luteal phase in IVF-ET cycles. Methods 449 IVF-ET cycles with long protocol of controlled ovarian hyperstimu-lation （COH） were retrospectively analyzed. The patients were divided into 3 groups according to the down-range of E2 level on ET day, group A：29 cycles, which the down-range of E2 was≤30%, received only progesterone as the luteal phase support;group B：186 cycles, which the down-range of E2 was 30%-50%,control group 113 cycles recived only progesterone as the luteal phase support, experience group 73 cycles received the same dosage of progesterone com-bined with oral E2 2mg/d as the luteal phase support; group C： 234 cycles,which the down-range of E2 was ≥50%, control group 124 cycles recived only progesterone as the luteal phase support,experience group 110 cycles received the same dosage of progesterone combined with oral E2 4mg/d as the luteal phase support. Results There were no differences on average age,duration of infertility, the number of retrieved oocytes, fertilization rates, cleavage rates and the number of transfer embryos （P〉0.05）; the clinical pregnancy rate were significant differences in statistic between the group A and control group B、 control group C（P〈0.05）; The clinical pregnancy rate of estradiol valerate supple-mentation group was significantly higher than that in the control group （P〈0.05）. Conclusion In IVF cycles, the rapidly decline of serum estradiol has the effection on the pregnancy outcome. Therefor, the proper estradiol valerate supplementation during the luteal phase may improve the endometrial recrptivity and the clinical pregnancy rate.