控制性超促排卵过程中添加低剂量人绒毛膜促性腺激素的效果分析

Analysis on the Efficacy of Adding Low-dose Human Chorionic Gonadotropin during Controlled Ovarian Hyperstimulation

目的:探讨在控制性超促排卵(COH)过程中添加低剂量人绒毛膜促性腺激素(hCG)的效果。方法:回顾性分析77例在COH过程中不同时间添加低剂量hCG进行促排卵患者的促排卵效果。结果:P水平在诱发排卵日[1.15(0.65,1.90)ng/ml]显著高于添加hCG日[0.30(0.20,0.56)ng/ml](P<0.05)。39个新鲜胚胎移植周期的生化妊娠率为46.2%(18/39),种植率为24.4%(20/82),临床妊娠率为35.9%(14/39);61个冻融胚胎移植周期的生化妊娠率为41.0%(25/61),种植率为18.4%(23/125),临床妊娠率为32.8%(20/61);无1例发生卵巢过度刺激综合征(OHSS);未孕患者中仍有10个周期还余有优质胚胎未移植。根据促排卵日不同时间添加低剂量hCG(50~200 mg/d)分组(A组≤5 d,n=9;B组6~8 d,n=26;C组9 d,n=19;D组≥10 d,n=23),各组的获卵率、受精率、卵裂率、优质胚胎数均无统计学差异。A^D组诱发排卵日P水平分别为1.00(0.5,1.6)ng/ml、1.32(0.7,2.6)ng/ml、1.30(0.6,2.2)ng/ml、1.09(0.7,1.5)ng/ml,均显著高于添加hCG日[分别为0.20(0.1~0.2)ng/ml、0.30(0.2,0.7)ng/ml、0.30(0.2,0.5)ng/ml、0.44(0.2,0.63)ng/ml](P<0.05或P<0.01)。结论:因卵泡生长缓慢、卵泡大小不均匀、卵泡数量过多,在COH过程中添加低剂量hCG对促排卵结局无影响,虽然诱发日的P水平会有所升高,但对新鲜胚胎移植周期的妊娠结局影响不显著,后续冻融胚胎移植的妊娠结局也较理想。

Objective： To analyze the effect of adding low-dose human chorionic gonadotropin（hCG） during controlled ovarian hyperstimulation（COH）.Methods： A total of 77 patients received low-dose hCG for ovarian stimulation during COH.The ovarian stimulation results were analyzed retrospectively.Results： Progesterone（P） level on the day of ovulation induction [1.15（0.65,1.90） ng/ml] was significantly higher than that on stimulation day with hCG [0.30（0.20,0.56） ng/ml]（P〈0.05）.There were 39 fresh embryo transfer cycles with biochemical pregnancy rate of 46.2%（18/39）,implantation rate of 24.4%（20/82）,clinical pregnancy rate of 35.9%（14/39）.There were 61 FET cycles with biochemical pregnancy rate of 41.0%（25/61）,implantation rate of 18.4%（23/125）,clinical pregnancy rate of 32.8%（20/61）.No OHSS occurred.Among the non-pregnant patients,there were still 10 cycles with good-quality embryos not to be transferred.The patients were divided into 4 groups according to the date of adding hCG,group A（≤ 5 d,n=9）,group B（6~8 d,n=26）,group C（9 d,n=19）,group D（≥ 10 d,n=23）.The rate of oocytes retrieved,the rate of fertilization,the rate of cleavage,the number of good-quality embryos of each group were not statistically different.From group A to group D,P levels on the day of ovulation induction [1.00（0.5,1.6） ng/ml,1.32（0.7,2.6） ng/ml,1.30（0.6,2.2） ng/ml,1.09（0.7,1.5） ng/ml,respectively] were significantly higher than those on stimulation day with hCG [0.20（0.1,0.2） ng/ml,0.30（0.2,0.7） ng/ml,0.30（0.2,0.5） ng/ml,0.44（0.2,0.63） ng/ml,respectively]（P〈0.05 or P〈0.01）.The biochemical pregnancy rate,implantation rate,clinical pregnancy rate were not statistically different between the fresh embryo transfer cycles and frozen embryo transfer cycles.Conclusion： Due to follicles’slow growth,uneven sizes,excessive amount,adding low-dose hCG during COH did not affect the outcome of ovarian stimulation.Although P level rose on the day of induction,it didn’t have a significant impact on pregnancy outcome in fresh embryo transfer and the pregnancy outcome of FET was still good.