不同hCG日判定标准对IVF/ICSI-ET治疗结局的影响

Effects of Different Criteria of hCG Administration on IVF/ICSI-ET Outcomes

目的:探讨强调主导卵泡直径大小和强调卵泡均称性2种不同的注射人绒毛膜促性腺激素(hCG)日标准对体外受精/胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)治疗结局的影响。方法:采用前瞻性随机对照研究,将2013年1月—3月在华中科技大学附属协和医院生殖中心行IVF/ICSI-ET助孕的不孕患者随机分为A、B组,A组采用强调主导卵泡直径大小的hCG日标准,B组采用强调卵泡均称性的hCG日标准;比较2组患者在各临床及实验室指标上的差异。结果:B组患者的平均促性腺激素(Gn)使用时间、hCG日孕酮和雌二醇浓度、平均获卵数、平均成熟卵数、成熟卵率等均高(大)于A组(P<0.05)。虽然2组患者可利用胚胎数及冷冻胚胎数差异并无统计学意义(P>0.05),但B组患者的临床妊娠率显著低于A组(42.19%vs.54.22%,χ2=4.18,P=0.04),且B组卵巢过度刺激综合征(OHSS)发生率显著高于A组(10.77%vs.5.86%,χ2=4.07,P=0.04)。结论:强调卵泡发育均称性的hCG日注射标准,在IVF/ICSI-ET有效性及安全性上并不优于传统的侧重主导卵泡大小的hCG日标准。

Objective：To explore the effects of two criteria of hCG administration on the clinical outcomes of IVF/ICSI-ET. These criteria were individually based on the follicle diameter and the follicle symmetry. Methods：It′s a prospective randomized study in our hospital reproductive center. IVF/ICSI-ET patients were randomly divided into two groups from Jan 2013 to Mar 2013. The criterion of hCG administration in Group A was based on the follicle diameter,while Group B on the follicle symmetry. Clinical and laboratory outcomes were then compared. Results：The average days of Gn, serum levels of progesterone and estradiol on the hCG day,the average number of matured eggs, and the rate of matured oocytes of group B were significantly higher than those of group A（P〈0.05）. There was not significant difference in the numbers of frozen embryos and good quality embryos between the two groups. However,the clinical pregnancy rate of group B was significantly lower than that of group A （42.19% vs. 54.22%, χ2=4.18,P=0.04）, and the incidence of OHSS in group B significantly higher than that of group A（10.77%vs. 5.86%,χ2=4.07,P=0.04）. Conclusions：The criterion based on the uniform size of follicular is not superior to the traditional criterion focused on the dominant follicle size in the efficacy and safety of IVF/ICSI-ET treatment.