注射人绒毛膜促性腺激素日雌激素水平对体外受精新鲜及冻融周期妊娠结局影响

The effect of different estradiol concentrations on the day of HCG administration on pregnancy outcome of fresh IVF cycles and subsequent frozen-thawed embryo transfer cycles

目的探讨体外受精(IVF)周期中注射人绒毛膜促性腺激素(HCG)日不同血清雌二醇(E2)水平对新鲜周期及随后胚胎冻融移植(FET)周期妊娠结局的影响。方法对2008年1月至2010年12月在上海交通大学医学院附属瑞金医院生殖医学中心接受常规IVF或卵胞浆内单精子注射(ICSI)助孕的820个周期进行回顾性分析,根据注射HCG日血清E2水平分为6组:A组(<7340pmol/L),B组(7340～<11010pmol/L),C组(11010～<14680pmol/L),D组(14680～<18350pmol/L),E组(18350～<22020pmol/L)和F组(≥22020pmol/L);为预防严重卵巢过度刺激综合征(OHSS)而放弃移植随后进行的首次FET周期,根据其取卵周期注射HCG日血清E2水平分为4组:Ⅰ组(14680～<18350pmol/L),Ⅱ组(18350～<22020pmol/L),Ⅲ组(22020～<25690pmol/L),Ⅳ组(≥25690pmol/L),比较各组妊娠结局。结果随着E2水平的增加,受精率、卵裂率均呈增高趋势(P<0.05);新鲜移植(ET)周期临床妊娠率、种植率及继续妊娠率A、B组略低,C、D、E、F组较高,但各组比较差异均无统计学意义(P>0.05)。全胚冻存后的首次FET周期,Ⅰ～Ⅳ组临床妊娠率、种植率和继续妊娠率差异无统计学意义(P>0.05)。总FET周期临床妊娠率(51.09%)和种植率(31.68%)明显高于总ET周期(38.90%,25.32%)(P<0.05)。结论促排卵周期中HCG日血清E2水平与IVF结局没有显著相关性,与随后FET结局也没有显著相关性。

Objective To evaluate the effect of different estradiol （ E2 ） concentrations on the day of human choiionic gon- adotrophin （HCG） administration on pregnancy outcome of fresh IVF cycles and subsequent frozen-thawed embryo trans- fer cycles. Methods 820 IVF/ICSI cycles between January 2008 and December 2010 performed in Reproductive Medi- cine Center of RuiJin Hospital Affilited of Shanghui Jiaotong University. were evaluated retrospectively. Serum E2 concen- trations on the day of HCG administration were categoiized into six groups： group A （ 〈 7340pmol/L）, group B （7340-〈ll010pmol/L）, group C （ll010- 〈 14680 pmol/L）, group D（ 14680- 〈 18350 pmol/L）, group E （18350 - 〈 22020 pmol/L）and group F （ ~〉 22020pmol/L）. The first frozen-thawed embryo transfer（FET） cycles in pa- tients with all-embryo cryopreservation to minimize the risk of severe OHSS were also categorized into four groups accord- ing to the E2 concentrations on HCG day in previous retrival cycles： group I （ 14680 - 〈 18350 pmol/L） , group ]I （ 18350 - 〈 22020 pmol/L）, group Ill （ 22020 ~ 〈 25690 pmol/L）, group 1V （ I〉 25690 pmol/L）. The pregnancy out- comes were analyzed. Results The fertilization rates and cleavage rates increased with the increasing E2 level（ P 〈 0. 05 ）. The pregnancy, implantation and ongoing pregnancy rates of groups A and B were lower than those of groups C - F. But there were no statistical significance （P 〉 0. 05 ）. The pregnancy, implantation and ongoing pregnancy rates of groups I - IV were similar （ P 〉 0. 05 ）. The pregnancy rate（51.09% ） and implantation rate（31.68% ） of first FET cycles in patients with all-embryo cryopreservation were higher dramatically than those of fresh cycles （38.90%, 25.32% ） （P 〈 0. 05 ）. Conclusion E2 levels on the day of HCG administration do not appear to affect pregnancy out- comes of IVF/ICSI or subsequent FET cycles.