控制性超促排卵中短暂高水平雌激素对不孕妇女心脏功能的影响

Influence of transient high estrogen level on cardiac function during controlled ovarian hyperstimulation in women with infertility

目的探讨控制性超促排卵对接受体外受精-胚胎移植技术治疗的不孕妇女心脏功能的影响。方法接受体外受精-胚胎移植技术治疗的不孕妇女60例,选取自然周期月经第3天、黄体生成素峰日、排卵后第7天及促排卵周期降调后月经第3天、注射人绒毛膜促性腺激素日、取卵后第7天和移植后第16天为监测点,分析比较自然周期与促排卵周期各个监测时间雌、孕激素水平及超声心动参数。结果自然周期雌、孕激素水平与促排卵周期比较差异有统计学意义(P<0.05);取卵后第7天患者左心室舒张末期容量、左室射血分数明显高于排卵后第7天(P<0.05);移植后第16天妊娠妇女保持雌、孕激素高水平,未妊娠妇女激素恢复到自然周期水平,心脏功能参数恢复到自然状态;左心室舒张末期容量、左室射血分数与雌激素水平呈正相关(r=0.380,P=0.042;r=0.390,P=0.030)。结论控制性超促排卵治疗对不孕女性心脏功能虽有一定风险,但仍是一种较安全的治疗方法。

Objective To explore the influence of high estrogen and progesterone levels during controlled ovarian hyperstimulation （COH） on cardiac function in patients receiving in vitro fertilization and embryo transfer （IVF-ET）. Methods The levels of estrogen and progesterone in serum and the parameters of echocardiography before COH （on the third day in natural menstrual cycle, on the day of luteotropic hormone surge, and by day 7 after ovulation） and during COH treatment （on the third day in cycle, by day 5 after gonadotropin administration, on the day of human chorionic gonadotrophin injection, by day 7 after oocyte pickup, and by day 16 after embryo transfer） were measured and analyzed in 60 patients receiving IVF-ET. Results There were significant differences in estrogen and progesterone levels between natural menstrual cycles and COH treatment cycles （P〈 0.05）. Left ventricular end-diastolic volume （LVEDV） and ejection fraction （LVEF） levels by day 7 after oocyte pickup were significantly higher than those on the third day in COH cycle （P〈0.05）. By day 16 after embryo transfer, estrogen and progesterone were maintained high levels in pregnant women, but estrogen and progesterone levels and parameters of echocardiography resumed to natural menstrual cycles in non-pregnant women; The LVEF and LVEDV were significantly correlated with estrogen level （r= 0. 380, P= 0. 042; r =0. 390, P=0. 030）. Conclusion The COH intervention is a relatively safe treatment although it has some risks for cardiac function.