人绒毛膜促性腺激素注射日血清雌孕激素及其比值对体外受精结局的影响

Effect of serum estradiol and progesterone level and progesterone/estradiol ratio on the day of human chorionic gonadotropin administration in pregnancy outcome of in vitro fertilization-embryo transplantation

背景:在体外受精-胚胎移植过程中,由于超促排卵,使多个卵泡发育,血清中的孕酮、雌二醇水平明显高于自然月经周期水平,其是否会导致卵子质量、子宫内膜接受性等发生变化,从而降低种植率和妊娠率,在国内外仍存在争议。目的:探讨注射人绒毛膜促性腺激素日血清雌孕激素及其比值对体外受精-胚胎移植妊娠结局的影响。方法:收集接受体外受精-胚胎移植治疗的218名不孕患者的资料,根据注射人绒毛膜促性腺激素日的血清雌二醇水平分为3组:雌二醇<3000ng/L组、3000ng/L≤雌二醇<5000ng/L组和雌二醇≥5000ng/L组;根据孕酮水平分为3组:孕酮≤0.9ng/L组、0.9ng/L<孕酮≤3ng/L组和孕酮>3ng/L组;根据孕酮/雌二醇比值分为2组:孕酮/雌二醇≤1组和孕酮/雌二醇>1组,回顾性分析其种植率和临床妊娠率。结果与结论:随着雌二醇水平和孕酮/雌二醇比值的升高,种植率和临床妊娠率下降,但差异无显著性(P>0.05),孕酮水平升高到3ng/L,种植率和临床妊娠率显著下降(P<0.01)。结果表明,人绒毛膜促性腺激素日血清高孕酮水平对体外受精-胚胎移植的种植率和临床妊娠率有不利影响。

BACKGROUND： Controlled ovarian hyperstimulation makes more follicular development, and serum progesterone and estradiol levels are significantly higher than natural menstrual cycles. However, it remains controversial whether this can change oocyte quality and endometrial receptivity, and reduce the implantation rate and clinical pregnancy rate. OBJECTIVE： To discuss the effect of serum estradiol and progesterone level and progesterone/estradiol （P/E2） ratio on the day of human chorionic gonadotropin （HCG） administration in pregnancy outcome of in vitro fertilization （IVF）-embryo transplantation （EF）. METHODS： A retrospective analysis was performed in the medical records of 218 patients undergoing IVF-ET treatment. Patients were divided into three groups according to serum estradiol concentration： E2 3 000 ng/L; 3 000 ng/L ≤ E2 5 000 ng/L and E2 ≥ 5 000 ng/L on the day of HCG administration. According to serum progesterone concentration： P ≤ 0.9 ng/L; 0.9 ng/L P ≤ 3 ng/L and P 3 ng/L. According to P/E2 ratio： P/E2 ratio 1 and P/E2 ratio ≤ 1. The implantation rate and clinical pregnancy rate were analyzed. RESULTS AND CONCLUSION： With the increased E2 levels and P/E2 ratio, the implantation rate and clinical pregnancy rate were slightly declined （P 0.05）. The implantation rate and clinical pregnancy rate were significantly decreased in P 3 ng/L group than the other two groups （P 0.01）. Results show that serum progesterone levels on the day of HCG administration have an adverse effect on implantation rate and clinical pregnancy rate in IVF-ET cycles.