人绒毛膜促性腺激素注射时机与超排卵方案

Timing of human chorionic gonadotrophin administration in controlled ovary stimulation protocols

选择最佳的人绒毛膜促性腺激素（HCG）时机是体外受精（IVF）成功的关键因素之一。HCG注射过早导致卵丘小而紧附卵泡壁，直接影响卵母细胞的回收率及卵母细胞的成熟度，受精率低。而HCG注射过晚导致卵母细胞受内源性LH峰的影响，过早的恢复了有丝分裂，错过受精的最佳时机；卵母细胞过熟可致卵母细胞超微结构异常，以至于受精、卵裂和妊娠率均受到影响；子宫内膜暴露雌孕激素时间延长，子宫内膜容受性改变，影响胚胎着床。因此，正确掌握合适的HCG时机是获得高质量卵母细胞，提高临床妊娠结局的关键。

Objective： To assess the relationship between the diameter of the dominant follicle and clinical pregnancy rate in different controlled ovary stimulation protocols. Methods： A total of 7462 patients received ovarian stimulation protocol in the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2012 were included in the study. All the patients were divided into 6 groups according to the diameter of leading follicle on the day of HCG administration. group A （≥20 mm）,group B （~19 mm andS20 mm）,group C （≥18 mm and 〈19 mm）,group D（≥17 mm and 〈18 mm）,group E（≥16 mm and （〈17 mm）and group F（〈16 mm）. Results： In long protocol of controlled ovarian hyperstimulation （COH） cycles,significant differences with regard to the number of oocytes collected, embryo implantation rate and clinical pregnancy rate were observed among the six groups （P〈0.05）. The embryo implantation rate and clinical pregnancy rate in group A were 34.41% and 50.58% respectively,which were higher than those in other groups. However, there were no differences in the fertilization rate, cleavage rate and good quality embryo rate in long protocol, super long protocol and modify super long protocol among the six groups. However, the abortion rates in group D,group E or group F were significant higher than those in group A,group B or group C （P dO. 05）. Conclusions： In long protocol of COH cycles,more oocytes collected and higher embryo implantation rate and clinical pregnancy rate can be obtained when the leading follicular diameter is larger than 20 mm on the HCG administration day. The abortion rate declines when the leading follicular diameter is larger than 18 mm on the HCG administration clay in super long protocol and modifies super long protocol.