晚卵泡期及胚胎移植日血清雌激素比值与体外受精结局的关系

Ratio of estradiol concentration of late-follicular phase to that at the day of embryo transfer has a predictive value for in-vitro fertilization outcome

目的探讨控制性超促排卵(COH)周期中晚卵泡期及胚胎移植日雌激素比值与体外受精-胚胎移植(IVF-ET) 结局的关系。方法 180例不育症患者行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,依其比值分为三组:组1:hCG日(雌二醇E2)／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58例妊娠(33．9％),妊娠组与非妊娠组及三组间比较,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;黄体期适当地补充雌激素将有利于妊娠结局。

Objective To study the effect of serum estradiol （E2） ratio between late-follicular phase and the day of embryo transfer on pregnancy during controlled ovarian hyperstimulation （COH）. Methods： In 180 infertility patients who underwent COH, serum estradiol was 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 （〈2.0）, group two （2.0-4.0）, and group three （〉4.0）. Results： A total of 58 pregnancies were noted （33.9%）. 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： Our study suggests that, in IVF cycle, the rapidly decline of the ratio of day-of-hCG estradiol to day-of-ET estradiol is important in predicting IVF success. We postulate that a dramatic drop in estradiol level may compromise the endometrial receptivity, and the proper supplementation of estradiol during luteal phase might be beneficial to improve some women＇s pregnant outcome.