不同雌激素水平卵巢高反应患者行单囊胚移植的妊娠结局

目的 探讨单囊胚移植在促排卵周期注射人绒毛膜促性腺激素（HCG）日不同雌激素水平卵巢高反应患者的妊娠结局。方法 回顾性分析卵巢高反应行胚胎移植1167个周期的临床资料，根据注射 hCG 日血清雌二醇( E2 )的浓度分组: E2＜ 5 000 pg/mL（n=278)组 ，其中D5单囊胚移植为A组、D3胚胎移植为B组：E2≥5 000 pg /mL（n = 889)组， 其中D5单囊胚移植为C组、D3胚胎移植为D组。比较A组与B组、C组与D组的一般资料及妊娠结局。结果 A组获卵数、成熟卵子数/MII数、2PN受精率、可移植胚胎数高于B组，双胎妊娠率、双胎分娩率低于B组，（P＜0.05），两组间着床率、妊娠率、流产率、活产率、中重度OHSS发生率的差异无统计学意义（P＞0.05）；C组bFSH、Gn剂量低于D组，AFC、获卵数、成熟卵子数/MII数、HCG日E2、P，2PN受精率、2PN卵裂率、可移植胚胎数、优质胚胎数高于D组，差异均有统计学意义（P＜0.01），C组着床率高于D组，双胎妊娠率、双胎分娩率及中重度OHSS发生率低于D组，差异有统计学意义（P＜0.05），两组间妊娠率、流产率、活产率差异无统计学意义（P＞0.05）。结论 单囊胚移植获得了较高妊娠率及活产率的同时显著降低了双胎妊娠率、双胎分娩率，尤其在较高雌激素水平下并未增高 OHSS 发生率。

Pregnant Outcome of Single-Blastocyst Transfer in High Ovarian Responders with the Different Level of Estradiol

Objective：To compare the pregnant outcomes of single-blastocyst transfer in those high ovarian responders with the different levels of serum estradiol on the day of human chorionic gonadotrophin (hCG) injection in their ovarian stimulation cycles. Methods：A total of 1 167 cycles in those high ovarian responders who performed embyo transfer in their fresh stimulation cycles were retrospectively analyzed. According to the concentration of serum estradiol (E2) on the day of hCG administration, 1 167 cycles were divided into four groups as follows. The group A (n=59) was the D5 single-blastocyst transfer group while E2＜5 000 pg/mL. The group B (n=219) was the D3 embyo transfer while E2＜5 000 pg/mL. The group C (n=387) was D5 single-blastocyst transfer while E2≥5 000 pg/mL. The group D (n=502) was the D3 embyo transfer while E2≥5 000 pg/mL. The basical characteristics and pregnancy outcomes were compared between the group A and B, and between the group C and D. Results：The number of retrieved oocytes，mature oocytes/MⅡ oocytes, 2PN fertility rate, number of embyo transfered in the group A were higher than those in the group B, while the twins pregnancy rate and twins delivery rate were lower than those in the group B (all P＜0.05). However, there were no significant differences in the implantation rate, clinical pregnancy rate, abortion rate, live birth rate and moderate-severe ovarian hyperstimulation syndrome (OHSS) between the group A and the group B (P＞0.05). The bFSH and the dose of gonadotroph in the group C were lower than the group D, while the AFC, the number of retrieved oocytes, mature oocytes/MⅡ oocytes, the concentrations of serum E2, progestron (P) on the day of hCG, 2PN fertility rate, 2PN cleavage rate, number of embyo transfered, number of high quality in the group C were higher than those in the group D (all P＜0.01). Interestingly, the implantation rate in the group C was higher than group D, while the twins pregnancy rate, twins delivery rate and the rate of moderate-severe OHSS were significantly lower than those in the group D (all P＜0.05). There were no significant differences in the clinical pregnancy rate, abortion rate, live birth rate between the group C and the group D (P＞0.05). Conclusions：Compared with the two cleavage embryos transfer，the single-blastocyst transfer under the different concentrations of E2 on the day of hCG stimulation can ensure the similar pregnancy rate and live bith rate, while significantly reduce the twins pregnancy rate and twins delivery rate. Meanwhile, the incidence of OHSS is not increased in those cycles with the higher level of estradiol.