短方案降调节hCG注射日前后血清雌孕激素水平变化及其比值对IVF/ICSI结局的影响

目的:探讨体外受精-胚胎移植(IVF-ET)中hCG注射日前后血清雌孕激素水平变化及其比值对妊娠结局的影响。方法:选取行短方案治疗的137例不孕症患者的临床资料,根据hCG注射日每成熟卵泡(B超下直径≥14 mm的卵泡)的E2水平分为3组,A1组E2水平<450 pg/ml,A2组E2水平450~600 pg/ml,A3组E2水平>600 pg/ml;据hCG注射日较前一日E2增幅程度不同亦分为3组,B1组增幅程度<20%,B2组增幅程度20%~30%,B3组增幅程度>30%;另外为探讨hCG注射日雌、孕激素比值对妊娠结局的影响,按hCG注射日E2/P值不同亦分为3组,C1组E2/P<3,C2组E2/P=3~5,C3组E2/P>5;对上述3组的临床资料进行回顾性分析。结果:A2组的临床妊娠率高于A3组,A1和A2组的胚胎种植率亦高于A3组,差异均有统计学意义(P<0.05);B1组的临床妊娠率明显高于B2和B3组,B1组的胚胎种植率亦高于B3组,差异均有统计学意义(P<0.05);C3组的临床妊娠率高于C1组,差异有统计学意义(P<0.05);C2、C3组的胚胎种植率明显高于C1组,差异有统计学意义(P<0.05)。结论:行IVF-ET患者的hCG注射日前后适合水平的血清雌、孕激素及其比值(E2水平在450~600 pg/ml,hCG注射日前后E2增幅<20%及E2/P>5)能获得较好的妊娠结局。

Influence of Serum Estradiol and Progesterone Concentration and Their Ratio on the IVF/ICSI Outcome before and on the Day of Human Chorionic Gonadotrophin Administration of Short Protocol

Objective: To explore the influence of serum estradiol and progesterone concentration and their ratio(E2/P) before and on the day of human chorionic gonadotrop(hCG) administration on the pregnancy outcome during in vitro fertiliztion and embryo transfer(IVF-ET).Methods: Clinical data of 137 infertility patients were divided into three groups according to the E2 levels on the day of hCG administration per mature follicles(under B-ultrasound diameter ≥ 14 mm),which were group A1< 450 pg/ml,group A2 450-600 gp/ml,group A3 >600 pg/ml.According to the increment of serum estradiol on the day of hCG administration related to the level on the day before hCG administration,the patients were also divided into three groups,group B1< 20%,group B2 20%-30%,group B3>30%.In addition,to investigate the ratio of estradiol and progesterone on the day of hCG administration on pregnancy outcome,the patients were divided into three groups,group C1<3,group C2 3-5,group C3>5.Then the retrospective analyses of the three groups were performed.Results: The clinical pregnancy rate in group A2 was higher than that in group A3,and the embryo implantation rate in group A1 and or group A2 was higher than that in group A3(P<0.05);the clinical pregnancy rate in group B1 was significantly higher than that in group B2 or group B3,the embryo implantation rate in group B1 was higher than that in group B3(P<0.05);E2/P of group C3 was higher than that in group C1(P<0.05);the embryo implantation rate in group C2 or group C3 was higher than that in group C1(P<0.05).Conclusion: The suitable level of serum estradiol and progesterone concentration and their ratio during in vitro fertiliztion and embryo transfer(IVF-ET) could make a better clinical outcome.