HCG扳机前E_2水平及变化对黄体期长方案IVF助孕结局的影响

目的研究黄体期长方案IVF/ICSI-ET助孕周期中,HCG扳机前雌二醇(E_2)水平及变化对助孕结局的影响。方法回顾性分析2011年1月至2014年8月在我院生殖中心采用黄体期长方案助孕的IVF/ICSI-ET周期1 913个,根据扳机日E_2水平变化分组:A组(1 664个周期),E_2上升;B组(249个周期),E_2下降。为研究E_2水平对妊娠结局的影响,又将A组分为两个亚组:A1组(1 038个周期,E_2≥14 640pmol/L)和A2组(626个周期,E_214 640pmol/L)。比较各组患者的一般资料、促排卵情况、胚胎发育情况及临床妊娠结局。结果 A、B两组的获卵数、移植数、冷冻数和受精率、卵裂率、优胚率无显著性差异(P0.05);A1组的获卵数和冷冻数显著高于A2组,移植数显著低于A2组(P0.05)。A、B两组鲜胚移植的种植率、临床妊娠率、活产率、多胎率、异位妊娠率、早期流产率和OHSS发生率均无显著性差异(P0.05);A1、A2组的活产率、多胎率、异位妊娠率和早期流产率亦无显著性差异(P0.05),A1组的种植率和临床妊娠率显著低于A2组,OHSS发生率显著高于A2组(P均0.05)。结论 HCG扳机前E_2升降对妊娠结局无明显不良影响,但扳机前过高的E_2可能会损害子宫内膜容受性继而影响胚胎着床,对妊娠结局造成不利影响。过高的E_2可能增加OHSS的发生率,因此建议对HCG扳机前E_2上升的高E_2患者,可考虑行全胚冷冻。

Effect of estradiol level before HCG trigger on pregnancy outcome of IVF-ET cycles with prolonged GnRH agonist protocol in luteal phase

Objective:To assess the impact of change and serum E2 level prior to HCG trigger on pregnancy outcome of IVF/ICSI with prolonged GnRH agonist protocol in luteal phase.Methods:The data of pregnancy outcome of 1913 IVF/ICSI-ET cycles with prolonged GnRH agonist protocol in Center for Reproductive Medicine,Renmin Hospital of Wuhan University between January 2011 and August 2014 were retrospectively analyzed.The cycles were divided into two groups:group A(E2 levels increase on HCG trigger day,n=1 664),group B(E2 levels reduction on HCG trigger day,n=249).In order to study the effect of E2 level on pregnancy outcome,group A were further subdivided into two groups:group A1(E2≥14 640 pmol/L,n=1 038)and group A2(E2＜14 640 pmol/L,n=626).The general information,ovulation induction,embryonic development and clinical pregnancy outcome were compared among the groups.Results:There were no significant differences in number of oocytes retrieved,number of embryos frozen,fertilization rate,cleavage rate,good-quality embryo rate,and implantation rate between group A and group B(P＞0.05).The number of oocytes retrieved and the number of embryo frozen in A1 group were significantly higher than those in group A2 (P＜ 0.05).There were no significant differences in implantation rate of fresh embryos,clinical pregnancy rate,live birth rate,multiple birth rate,ectopic pregnancy rate,early abortion rate and OHSS incidence between group A1 and A2(P＞0.05).There were no significant differences in the live birth rate,multiple birth rate,ectopic pregnancy rate and early abortion rate between group A1 and A2 (P＞0.05).However,the implantation rate and clinical pregnancy rate in group A1 were significant lower than those in group A2,and the OHSS incidence in group A1 was significant higher than that in group A2(P＜0.05).Conclusions:The reduction of E2 levels before HCG trigger did not show a significant adverse effect on the pregnancy outcome,but the excessive serum E2 level prior to HCG trigger may increase OHSS incidence.Therefore,it is recommended to consider whole embryo frozen for the patients with excessive serum E2 level prior to HCG trigger.