晚卵泡期及黄体早期血清雌激素比值与体外受精结局的关系

目的探讨控制性促排卵（COH）周期中晚卵泡期及黄体早期雌激素比值与体外受精-胚胎移植（IVF—ET）结局的关系．方法194例因输卵管因素不孕的患者行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3组：组1：hCG日E2（雌二醇）／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67例妊娠（34．5％），妊娠组与非妊娠组及不同E2比值的三组间比较，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，黄体期适当补充雌激素将有利于妊娠结局．

The Relationship between the Ratio of Estradiol Concentration of Late-follicular Phase to Earlier Period of Luteum and In-vitro Fertilization Outcome

Objective To study the effects of the relationship between the ratio of serum estradiol(E_2) of late-follicular phase to earlier period of luteum and in-vitro fertilization outcome on pregnancy during controlled ovarian hyperstimulation(COH).Methods 194 infertility patients underwent COH because of uterine tube and their serum estradiol were 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(r<2.0),group two (2.0~4.0),and group three(r>4.0).Results 67 pregnancies were noted(34.5%).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 It is suggested that in IVF cycle,the rapid decline of the ratio of day-of-hCG estradiol to day-of-ET estradiol is important in predicting IVF success.We presumed that a dramatic drop in estradiol level may damage the endometrial receptivity,and the proper supplementation of estradiol during luteal phase might be beneficial to improve some women's pregnant outcome.