控制性超促排卵后不同卵巢反应对体外受精妇女妊娠结局的影响

目的 观察控制性超促排卵（COH）后不同卵巢反应对体外受精妇女妊娠结局的影响。方法 分析1 310例因输卵管和（或）男性因素接受第一周期体外受精/卵胞质内单精子注射-胚胎移植（IVF/ICSI-ET）治疗的不孕妇女的临床资料。根据COH周期中人绒毛膜促性腺激素（hCG）日血清雌二醇(E₂)质量浓度，按百分位0%～10%、11%～25%、26%～75%、76%～90%、91%～100%将卵巢反应程度分为低反应组（A组）、低中反应组（B组）、中反应组（C组）、中高反应组（D组）和高反应组（E组）。比较各组卵子、胚胎发育情况以及妊娠结局。结果 所有患者的临床妊娠率为44.73%，着床率为30.05%，流产率为3.73%。A～E组MⅡ卵数逐渐递增，组间差异有统计学意义（P<0.01）；优质胚胎数也呈递增趋势，除D组与E组间差异无统计学意义外，其余各组间的差异均有统计学意义（P<0.01）。A组、D组和E组平均移植胚胎数显著低于B组和C组（P<0.01）。C组周期取消率最低，D组和E组的周期取消率高于B组和C组（P<0.05或P<0.01）。A～C组妊娠率和着床率递增，C～E组妊娠率和着床率递减；C组妊娠率和着床率均显著高于A组和E组（P<0.05或P<0.01）。各组间流产率比较，差异无统计学意义（P>0.05）。结论 卵巢低反应和高反应均不利于体外受精的妊娠结局。

Effect of different ovarian response after controlled ovarian hyperstimulation on pregnancy outcome of women undergoing in vitro fertilization

Objective To investigate the effect of different ovarian response after controlled ovarian hyperstimulation (COH) on pregnancy outcome of women undergoing in vitro fertilization. Methods The clinical data of 1 310 women undergoing first cycle of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) due to male and/or tubal factor were analysed. According to the percentiles of serum E₂ levels on the day of human chorionic gonadotrophin (hCG) administration, poor ovarian response group (group A, 0% to 10%), low-mid ovarian response group (group B, 11% to 25%), mid ovarian response group (group C, 26% to 75%), mid-high ovarian response group (group D, 76% to 90%) and high ovarian response group (group E, 91% to 100%) were divided. The numbers of oocytes retrieved, embryo development and pregnancy outcomes were compared among groups. Results The rate of clinical pregnancy was 44.73% for all the patients, and the implantation rate and abortion rate were 30.05% and 3.73% respectively. The numbers of MⅡ oocytes significantly increased from group A to group E (P<0.01). The numbers of good quality embryos increased from group A to group E, and there were significant differences among groups (P<0.01) except for group D and group E. The numbers of embryos transfered in group A, group D and group E were significantly smaller than those in group B and group C (P<0.01). The cycle cancellation rate was the lowest in group C, and the cycle cancellation rates in group D and group E were significantly higher than those in group B and group C (P<0.05 or P<0.01). The pregnancy rates and implantation rates increased form group A to group C, and those decreased from group C to group E. The pregnancy rate and implantation rate in group C were significantly higher than those in group A and group E (P<0.05 or P<0.01). There was no significant difference in the abortion rate among groups (P>0.05). Conclusion Both low ovarian response and high ovarian response are detrimental to pregnancy outcome of women undergoing in vitro fertilization.