控制性超排卵中卵巢高反应对体外受精-胚胎移植/卵胞浆内单精子注射周期妊娠结局的影响

Pregnancy outcome in hyper-responders during controlled ovarian hyperstimulation in IVF/ICSI cycles

目的研究体外受精-胚胎移植／卵胞浆内单精子注射（IVF／ICSI）周期控制性超排卵（COH）中卵巢高反应对妊娠结局的影响。方法回顾性分析本生殖中心2003年1月至2005年12月的IVF／ICSI周期临床资料，根据雌二醇（E2）峰值百分位数确定卵巢反应，分为P25-75（E24，302～10，791pmol／L），530个周期，定义为正常反应组（A组），Ez水平在P75～90（E210，792～14，669pmol／L）159个周期，为中度高反应组（B组），P90以上（E2≥14，670pmol／L），105个周期为高反应组（C组），比较各组妊娠结局。结果与A组相比，B和C组获卵数显著增多（P〈0．01），但卵母细胞质量和临床妊娠率无显著差异（P〉0．05）。C组着床率（21．4％）显著低于A组（29．7％）（P〈0．05），3组早期流产率无显著差异（P〉0．05）。结论COH中卵巢高反应对胚胎质量无显著影响，但着床率降低，提示高雌激素环境影响子宫内膜容受性。

Objective： To evaluate the pregnancy outcome in hyper-responders during controlled ovarian hyperstimulation with GnRH agonist and rFSH in IVF/ICSI cycles. Methods： This retrospective study included 1,058 IVF/ICSI cycles performed from January 2003 to December 2005 in our reproductive center. Ovarian responses were grouped according to the percentile E2 on the day of hCG administration. Group A consisted of normal responders defined as women with oestradiol concentrations between the 25th and 75th percentiles （4,302-10,791 pmol/L, 530 cycles）, group B consisted of moderately high responders, defined as women with oestradiol concentrations between the 75th and 90th percentile （10,792-14,669 pmol/L, 159 cycles）. Group C was set the cut-off concentration for hyper-responders as the 90th percentile and above （≥14,670 pmol/L, 105 cycles）. The pregnancy outcomes among three groups were analyzed with ANVOA and chi-square test. Results： The numbers of follicles, oocytes and fertilized embryos were significantly different in three groups （P〈0. 05）, but there were no differences in oocyte retrieval rate, fertilization rate and high-grade embryo rate. Pregnancy rate was lower but with no significantly difference in hyper-responders＇ group （P〉0.05）. Implantation rate in group C was lower than that in normal responders（21.38% vs. 29.74%, P〈0.05）. There were no difference in miscarriage rate during the first trimester among three groups （P〉0.05）. Women with moderate and severe ovarian hyperstimulation increased with the E2 levels （P〈0. 05）. Conclusions. The results suggest that hyper-response to the controlled ovarian hyperstimulation would not affect the oocyte quality and pregnancy rate, but significantly affect the implantation rate. High oestradiol concentrations during ovarian stimulation might expose the embryos to a sub-optimal endometrial environment.