控制性超促排卵后不同卵巢反应对体外受精妇女妊娠结局的影响

Effect of different ovarian response after controlled ovarian hyperstimulation on pregnancy outcome of women undergoing in vitro fertilization

目的观察控制性超促排卵(COH)后不同卵巢反应对体外受精妇女妊娠结局的影响。方法分析1 310例因输卵管和(或)男性因素接受第一周期体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)治疗的不孕妇女的临床资料。根据COH周期中人绒毛膜促性腺激素(hCG)日血清雌二醇(E_2)质量浓度,按百分位0%～10%、11%～25%、26%～75%、76%～90%、91%～100%将卵巢反应程度分为低反应组(A组)、低中反应组(B组)、中反应组(C组)、中高反应组(D组)和高反应组(E组)。比较各组卵子、胚胎发育情况以及妊娠结局。结果所有患者的临床妊娠率为44.73%,着床率为30.05%,流产率为3.73%。A～E组MⅡ卵数逐渐递增,组间差异有统计学意义(P<0.01);优质胚胎数也呈递增趋势,除D组与E组间差异无统计学意义外,其余各组间的差异均有统计学意义(P<0.01)。A组、D组和E组平均移植胚胎数显著低于B组和C组(P<0.01)。C组周期取消率最低,D组和E组的周期取消率高于B组和C组(P<0.05或P<0.01)。A～C组妊娠率和着床率递增,C～E组妊娠率和着床率递减;C组妊娠率和着床率均显著高于A组和E组(P<0.05或P<0.01)。各组间流产率比较,差异无统计学意义(P>0.05)。结论卵巢低反应和高反应均不利于体外受精的妊娠结局。

Objective To investigate the effect of different ovarian response after controlled ovarian hyperstimulation （COH） on pregnancy outcome of women undergoing in vitro fertilization. Methods The clinical data of 1 310 women undergoing first cycle of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET） due to male and/or tubal factor were analysed. According to the percentiles of serum E2 levels on the day of human chorionic gonadotrophin （hCG） administration, poor ovarian response group （ group A, 0% to 10% ）, low-mid ovarian response group （group B, 11% to 25%）, mid ovarian response group （group C, 26% to 75%）, mid-high ovarian response group （group D, 76% to 90%） and high ovarian response group （group E, 91% to 100%） were divided. The numbers of oocytes retrieved, embryo development and pregnancy pregnancy was 44. 73% for all the patients, outcomes were compared among groups. and the implantation rate and abortion Results The rate of clinical rate were 30. 05% and 3. 73% respectively. The numbers of M l] oocytes significantly increased from group A to group E （ P 〈 0.01）. The numbers of good-quality embryos increased from group A to group E, and there were significant differences among groups （P 〈0.01） except for group D and group E. The numbers of embryos transfered in group A, group D and group E were significantly smaller than those in group B and group C （P 〈 0.01）. The cycle cancellation rate was the lowest in group C, and the cycle cancellation rates in group D and group E were significantly higher than those in group B and group C （P 〈 0.05 or P 〈 O. 01）. The pregnancy rates and implantation rates increased form group A to group C, and those decreased from group C to group E. The pregnancy rate and implantation rate in group C were significantly higher than those in group A and group E （P 〈 0.05 or P 〈 0.01）. There was no significant difference in the abortion rate among groups （ P 〉 0. 05）. Conclusion Both low ovarian response and high ovarian response are detrimental to pregnancy outcome of women undergoing in vitro fertilization.