三种子宫内膜准备方案胚胎移植日血清雌孕激素水平、胚胎种植率、临床妊娠率的比较研究

目的探讨超排卵(Super-ovulation)控制性超排卵(controlled ovarian hyperstimulation,COH)和雌孕激素替代治疗(hormone replacement treatment,HRT)三种子宫内膜准备方案对胚胎移植日血清雌孕激素水平、人胚胎种植率及临床妊娠率的影响。方法2004年1月至2005年10月在我中心采用不同治疗方案行IVF-ET的不孕妇女分为3组:超排卵组、控制性超排卵组和雌孕激素替代治疗组。体外受精-胚胎移植按我中心常规方法进行。酶联免疫吸附双抗夹心法(ELASA)检测ET日血清雌孕激素水平。各组IVF ET的实验室和临床资料进行分析比较。结果同期COH组超排卵药物总剂量和获卵数分别为(30.12±10.18)支和(10.35±2.01)个,明显高于超排卵组(8.21±4.19)支和(5.05±3.11)个(P<0.05);COH组胚胎种植率和临床妊娠率分别为21.19%和34.55%,明显低于HRT组(34.9,52.38%)和超排卵组(32.43%,50%)(P<0.05)。COH组ET日E_2水平(825.24±558.95 pg/mL),明显高于超排卵组(395.8±287.27pg/mL)及HRT组(407.72±123.76pg/mL)(P<0.05)。COH组P水平(109.31±82.61 ng/mL)明显高于HRT组(62.63±31.54 ng/mL)(P<0.05),而与超排卯组比较无明显差异(P>0.05)。COH组E_2/P比值(8.34±1.76)明显高于超排卵组(4.51±2.32)及HRT组(5.96±3.87)(P<0.05)。结论COH组胚胎种植率和临床妊娠率低于HRT组和超排卵组。COH组超生理的雌激素水平可能影响人胚胎种植率和临床妊娠率。

Objective To evaluate effects on the level of E2, P in blood serum ,human implantation rate and clinical pregnancy rate based on different protocols. Methods From January 2004 to August 2005, patients undergoing treatment for IVF-ET were recruited from the reproductive center of The First Affiliated Hospital of Zheng Zhou University. According to the treatment protocols, the recruited patients were divided into 3 groups： Superovulation group, COH group , HRT group .The method of IVF ET was done in a routine way in our center. The enzyme linked immunosorbent assay （ELISA） is used to quantify E2 and P in blood serum on embryo transfer day. The laboratory data and clinical material of IVF-ET were collected and analysed. Results The amounts of gonadotropin （Gn） and the oocytes number in COH group are （30.12 ± 10.18）, （10.35 ±2.01）, significantly higher than that in superovulation group （8.21 ± 4.19）, （5.05 ± 3.11）（P 〈 0.05）. The implantation rate and clinical pregnancy rate in COH group are 21.19%,34.55%, significantly lower than that in HRT group （34.9,52.38%） and superovulation group （32.43%,50%） （P〈 0.05）. The E2 level in blood serum on ET day of COH group is （825.24 ± 558.95） pg/ml, significantly higher than that in superovulation group and HRT group （395.8 ±287.27） pg/mL, （407.7± 123.76） pg/mL （P〈 0.05）. The level of P （109.31 ± 82.61 ng/mL） of COH group is significantly higher than that in HRT group （62.63 ± 31.54 ng/ ml） （P 〈0.05）. The ratio of E2/P in COH group （8.34 ± 1.76） is significantly higher than that in superovulation group （4. 51 ± 2.32）and H RT group （5.96 ± 3.87）（P 〈 0.05）. Conclusion The implantation rate and clinical pregnancy rate in C OH group is significantly lower than that in superovulation group and HRT group.High concentrations of E2 caused by ovarian stimulation may affect the human implantation rate and clinical pregnancy rate.