黄体期个体化雌激素补充方案对IVF-ET治疗结局的影响

Effect of Individual Estradiol Supplementation during the Luteal Phase in in-vitro Fertilization Outcome

目的:探讨黄体期个体化添加不同剂量雌激素对体外受精-胚胎移植(IVF-ET)胚胎种植率和临床妊娠率的影响。方法:回顾性分析104个长方案控制性促排卵(COH)IVF-ET周期,根据其移植日血清E2水平下降幅度分为4组,A组:E2下降<30%,12个周期,单用黄体酮进行黄体期支持;B组:E2下降30%-39%,18个周期,黄体期支持采用黄体酮+3mg/d雌激素;C组:E2下降40%-49%,16个周期,D组:E2下降≥50%,58个周期,C组、D组患者黄体期支持采用黄体酮+4mg/d雌激素。结果:各组的取卵数目、受精率、卵裂率、优质胚胎数、内膜厚度和移植胚胎数相比差异均无显著性(P>0.05)。A组、B组、C组间胚胎种植率和临床妊娠率无统计学差异;而D组与其余3组比,胚胎种植率和临床妊娠率显著下降(P<0.05)。结论:①在长方案COH的IVF-ET中,当移植日血清E2水平下降幅度≥30%时黄体期支持补充雌激素可以改善胚胎种植率和临床妊娠率;②E2下降幅度大的患者可能需要增加雌激素的添加剂量。

Objective： To study the effect of individual estradiol supplementation during the luteal phase in in vitro fertilization. Methods： A total of 104 long protocol COH and IVF-ET cycles were divided into 4 groups according to the down-range of serum E2 level on the ET day. Group A： 12 cycles, which the down-range of E2 was 〈30%, received only progesterone as the luteal phase surport. Group B： 18 cycles received the same dosage of progesterone, combined with oral E23 mg/d for the patients who the down-range of E2 was 30%,4-39%. Group C： 16 cycles received the same dosage of progesterone combined with oral E2 4 mg/d for the patients who the down-range of E2 was 40%-49%. Group D： 58 cycles received the same dosage of progesterone combined with oral E2 4 mg/d for the patients who the down-range of E2 was ≥ 50%. Results： There was no difference on average age, endometrium thickness, fertilization rates, embryo cleavage rates, and quantity or quality of embryos transferred in four groups. There was no difference on the embryo implantation rate and the clinical pregnancy rate among group A, B, C. And the embryo implantation rate and clinical pregnancy rate of group D were still significantly lower than those in other groups （P〈0.05）. Conclusions： 1） In long protocol COH and IVF-ET cycles, the estradiol supplementation was necessary during the luteal phase surport for the patients whose down-range of E2 level on ET day was more than 30%. 2） The dose of the estradiol supplementation should be individual according to the down-range of the serum E2 level.