IVF/ICSI-ET周期hCG注射次日雌二醇(E_2)水平变化的意义

Association between Serum Estradiol Level on the Next Day of hCG Administration and IVF/ICSI-ET Outcome

目的：探讨体外受精，卵胞质内单精子注射．胚胎移植（IVF／ICSI—ET）周期中hCG注射次日血清雌二醇（E2）水平较hCG注射日的增幅对超促排卵临床结局的预测价值。方法：回顾性分析362例行黄体中期长方案IVF／ICSI．ET患者的临床资料。hCG注射次日E2增幅=（hCG注射次日血清E2水平-hCG注射日E2水平）／hCG注射日E2水平×100％。根据增幅的不同分成4组：A组增幅〉20％，B组增幅为0．1％～20％间，C组为-20％～O％间，D组增幅〈-20％。分析4组患者基本，临床资料、超促排卵情况以及临床结局各项指标。结果：各组患者的取卵年龄、不孕年限、基础FSH（bFSH）值、降调节剂量、rFSH天数、hCG用量、hCG注射日LH值、2原核（2PN）胚胎数、优质胚胎数、冷冻胚胎数各组间差异均无统计学意义。各组患者的Gn启动剂量、Gn总用量、hCG注射日P值差异均有统计学意义（P〈0．05），且各值随着E2增幅的降低逐渐升高。A组的临床妊娠率（56．30％）显著高于B、C、D组（40．27％、42．85％和20．00％），差异有统计学意义（P〈O．05）。A组的胚胎种植率（33．86％）虽高于B、C、D组（26．23％、28．65％和16．67％），但差异无统计学意义（P〉0．05）。结论：监测黄体中期长方案垂体降调节IVF／ICSI．ET患者hCG注射次日E2增幅水平对临床结局有预测意义，E2水平在hCG注射次日较hcG注射日增幅高达20％以上时，临床结局较好。

Objective： To evaluate the value of estradiol （E2） levels on the next day of human chorionic gonadotrophin （hCG） administration in predicting the clinical outcomes of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET）. Methods： A retrospective analysis of the IVF/ICSI-ET data was conducted involving 362 patients who received a long gonadotrophin-releasing hormone agonist （GnRHa） protocol. According to the increment of serum E2 ratio on the second day of hCG administration （relative to the level on the day of hCG administration）, the patients were categorized into 4 groups： group A〉20%, group B between 0.1% and 20%, group C between -20% and 0%, and group D〈-20%. The hormonal characteristics and clinical outcomes of the IVF-ET cycles were analyzed comparatively. Results： There were statistical differences in priming FSH dose, total FSH administered dose, progesterone （P） levels on the day of hCG injection among four groups. The clinical pregnancy rate was significantly higher in group A （56.30%） than in groups B, C and D （40.27%, 42.85% and 20.00%, respectively, P〈0.05）. Even though higher implantation rate was observed in group A （33.86%） compared with other 3 groups, but the differences of implantation rate were not significant （P〉0.05）. Conclusion： The variation of serum E2 shows an important impact on the clinical outcomes of IVF/ICSI-ET in patients receiving long GnRHa protocol. Favorable outcomes can be expected when serum E2 increment ratio on the next day of hCG administration is above 20%.