HCG日血清高雌二醇患者体外受精-胚胎移植妊娠结局的影响因素分析

Impact factors on the outcome of in vitro fertilization for women with high serum estradiol level on HCG day

胚胎种植成功最关键的因素是子宫内膜的容受性。目前的研究认为，雌、孕激素水平及其在子宫内膜的受体共同协调节子宫内膜的同步发育和容受性。体外受精一胚胎移植（IVF—ET）中，因控制性超排卵引起多卵泡同步发育产生超生理血清雌二醇（E2）水平。

Objective：To investigate the main impact factors which affect the outcome of in-vitro iertilization （IVF）for women with high serum estradiol（E2）level on HCG day. Methods：A total of 404 infertile women were divided into 4 groups according to the age, and the general parameters and clinical outcomes were compared in the different groups. Among them, the embryo transfer in 4 patients was cancelled due to no embryo available,and 124 patients＇ embryos were frozen due to the risk of ovarian hyperstimulation syndrome（OHSS）or for the other reasons. According to the serum progesterone（P）levels,276 fresh embryo transfer cycles were divided into two groups（P（4.77 nmol/L, n=237;P≥4.77 nmol/L,n=39）. Additionally,the 276 cycles were divided into two groups according to pregnancy outcome（pregnancy, n = 129; non-pregnancy, n= 147）. The general parameters and clinical outcomes were compared between the different groups. Results. For the women undergoing IVF with high serum Ez levels on HCG day, the proportion of those with serum P≥ 4.77 nmol/L increased with age （P = 0. 004）. The clinical pregnancy rate and implantation rate decreased with age but the differences were not statistically significant（P〉0.05）. The clinical pregnancy rate and implantation rate of women with high serum P level（P≥4.77 nmol/L）were significantly lower than those with low serum P level （P（4.77 nmot/L）（P = 0.004 and 0.048, respectively）. The serum P level and the proportion of women with high serum P level（P≥4.77 nmol/L） on the HCG day in non-pregnancy group were significantly higher than those in pregnancy group （P=0. 003 and 0. 004,respectively）,while the number of embryos available for transfer was significantly lower（P=0. 013）. Conclusions. For the women undergoing IVF with high serum E2 level on HCG day,the early rise of progesterone appeared more frequently in aged patients. High serum progesterone levels on HCG day may play a negative role in the receptivity of endometrium.