人绒毛膜促性腺激素注射日孕酮水平和体外受精/细胞质内单精子注射-胚胎移植妊娠结局的关系

Impact of progesterone level on the day of human chorionic gonadotrophin administration on outcome of IVF/ICSI-ET

目的探讨在体外受精/细胞质内单精子注射-胚胎移植(IVF/ICSI-ET)周期中,人绒毛膜促性腺激素(HCG)注射日孕酮(P)水平与妊娠结局的关系。方法回顾性分析2012年9月至2013年2月在我院生殖中心行IVF/ICSI-ET的198个新鲜周期。按照HCG日血清P水平的不同分为3组,A组:P<1ng/mL者96周期;B组:1ng/mL≤P<1.5ng/mL者72周期;C组:P≥1.5ng/mL者30周期。结果 B组的获卵数(16±7)高于A组(13±5)和C组(12±5),差异具有统计学意义。B组的妊娠率(51.4%)显著高于A组(40.6%)和C组(36.7%),A组的妊娠率(40.6%)显著高于C组(36.7%),差异均具有统计学意义。B组的活产率(78.4%)显著高于C组(72.7%)和A组(69.2%),C组的活产率(72.7%)显著高于A组(69.2%),差异均具有统计学意义。而各组间年龄、不孕年限、促性腺激素释放激素(GnRHa)总量、成熟卵率、受精率、卵裂率、优质胚胎率、移植胚胎数及种植率间差异无统计学意义。结论在IVF/ICSI-ET周期中,HCG日孕酮水平的高低直接影响获卵数、妊娠率及活产率,但不影响成熟卵率及胚胎的质量。HCG日1ng/mL≤P<1.5ng/mL时,具有最佳妊娠率及活产率。

Objective To evaluate the impact of progesterone level on the day of human chorionic gonado-trophin administration on pregnancy outcome of IVF/ICSI cycles .Methods Retrospective analysis of 198 cycles of IVF/ICSI-ET in our reproductive medical centre from September 2012 to February 2013 was performed .All the patients were divided into three groups according to serum progesterone level on the day of HCG administration , group A ：P＆lt;1 ng/mL 96 cycles ;group B：1 nmol/mL≤P〈1 .5 ng/mL 72 cycles ;group C ：P≥1 .5 ng/mL 30 cycles .Results The number of retrieved oocytes in group B（16 ± 7） was significantly higher than that in group A （13 ± 5） and group C（12 ± 5） ,the differences were statistically significant .The pregnancy rates in group B（51 . 4% ） was significantly higher than that in group A （40.6% ）and group C （36.7% ） .Also ,the pregnancy rates in group A（40.6% ） was significantly higher than that in group C（36.7% ） ,all the differences were statistically sig-nificant .The live birth rate in group B（78.4% ） was significantly higher than that in group C（72.7% ）and group A （69.2% ） .Also ,the live birth rate in group C（72.7% ） was significantly higher than that in group A （69.2% ） ,all the differences were statistically significant .Their age ,infertility duration ,the total dose of gonadotrophin ,the mature rate of the oocytes ,fertilization rates ,embryos cleavage rates ,high quality embryos rates ,ET embryos and implantation rate were of no significant difference in all groups .Conclusion The level of progesterone on the day of human chorionic gonadotrophin administration has effect on the number of retrieved oocytes ,the pregnancy rates and the live birth rate ,but has no effect on the mature rate of the oocytes and the quality of embryos in vitro fertilization/intracytoplasmic sperm injection cycles .On the day of hCG administration ,the pregnancy rates and the live birth rate was best when the level of progesterone was between 1ng/ml or greater and 1 .5ng/ml.