体外受精-胚胎移植周期中雌激素水平与妊娠的关系

The Relationship between the Level of Serum Estrogen (E_2) and Pregnancy in vitro fertilization-embryo transfer cycle

目的探讨控制性促排卵(COH)周期中雌激素水平与体外受精-胚胎移植(IVF-ET)结局的关系以及补充雌激素的必要性。方法200例因输卵管因素和(或)男方因素不孕行COH的患者,于注射人绒毛膜促性腺激素(hCG)日及ET第5日测定血清雌激素(E2)水平,根据注射HCG后E2变化分为增高组(<0)和降低组(>0),降低组计算HCG注射后E2下降百分比(E2%),根据E2降低百分比分为6组:1组E2下降幅度<20%,2组E2下降幅度为20%～29%,3组E2下降幅度30%～39%,4组E2下降幅度40%～49%,5组E2下降幅度50%～59%,6组E2下降幅度≥60%。结果COH后共有86例临床妊娠(43%),妊娠组与非妊娠组间比较,患者年龄、hCG日E2水平、获卵数、受精率、ET日E2水平的差异均无统计学意义;E2升高组与降低组临床妊娠率的差异均无统计学意义;不同E2下降幅度的6组间:ET后第5日E2第1组、第6组分别与其他四组相比,差异均有统计学意义;HCG日E2第6组与其他5组相比,差异均有统计学意义,妊娠率差异无统计学意义。结论推测在IVF周期中,hCG日至ET第5日E2值迅速下降幅度可预测妊娠结局,雌激素水平迅速下降可能损害子宫内膜的容受性,黄体期适当补充雌激素可能有利于妊娠结局。

Objective To investigate the relationship between estrogen levels of controlled ovarian hyperstimulation（COH） cycle and in vitro fertilization-embryo transfer（IVF-ET） outcome.Methods 200 cases who due to tubal factors and（or） male factor infertility underwent COH,tested serum estrogen（E2） levels on the day of injecting human chorionic gonadotropin（hCG） and ET on the 5th day.According to changes in E2after the injection of HCG,they were divided into increased group（〈0） and decreased group（〉0）.In the decreased group,to calculate the ratio of the minus of serum E2 levels on the day of injecting hCG,or E2% =（HCG day E2-transplant 5th day E2） / HCG day E2 × 100.They were divide into 6 groups according to the percentage of reduced E2： group 1 E2decreased of〈 20%,group 2 E2decreased of 20%-29%,group 3 E2decreased of 30%-39%,groups 4 E2decreased of 40%-49%,groups 5 E2 declined from 50% to 59%,group 6 E2 decreased ≥ 60%.Results There were 86 cases of clinical pregnancy（43%）,patient′s age,hCG day E2levels,number of retrieved oocytes,fertilization rate,ET on the level of E2 were not different significantly between the pregnancy group and non-pregnant group.In the dropped six groups： ET on the 5th day,E2of the first group,the sixth group were different compared with the other four groups;HCG day,E2of the sixth group were different compared with the other five groups.Conclusion Combination of published literature,in IVF cycles,the rapid decline in E2of hCG day and ET on the 5th day can predict the outcome of pregnancy,the rapid decline in estrogen levels might impair endometrial receptivity,and the suitable complement to the luteal phase estrogen may be benefit to pregnancy outcome.