微刺激与自然周期单个卵泡的卵泡容积与IVF-ET/ICSI助孕结局的关系

The Relationship between Single Follicle Volume and IVF-ET/ICSI Outcomes in Natural Cycles and Minimal Stimulation Cycles

目的：通过超声观察自然周期及微刺激周期单个卵泡发育情况,探讨卵泡容积大小与体外受精-胚胎移植（IVF-ET）/胞浆内单精子注射（ICSI）妊娠结局的关系。方法：回顾性分析2007年4月—2012年5月南京医科大学第一附属医院临床生殖医学科微刺激周期及自然周期单个卵泡行IVF-ET/ICSI助孕妇女1480例的临床资料,并按卵泡容积大小分为≥5.5 m L组（A组）,4.5-5.0 m L组（B组）,3.5-4.0 m L组（C组）,2.5-3.0 m L组（D组）及1.0-2.0 m L组（E组）,对照观察各组IVF-ET/ICS助孕结局。结果：1各组自然周期与微刺激周期随着人绒毛膜促性腺激素（h CG）日卵泡直径逐渐减小,卵泡容积逐渐减小,各组间差异有统计学意义（P〈0.001）。2在自然周期中A组的临床妊娠率和活产率均仅为11.8%,而其他4组临床妊娠率在20.0%-25.0%之间,活产率在15.8%-20.0%,但各组差异无统计学意义（P〉0.05）。A组有较高的可移植胚胎率和较低的未受精率,但与D组和C组比较,其未获卵率较高（为32.6%）,差异有统计学意义（均P〈0.01）,有胚胎可移植周期仅占总周期的39.53%（17/43）;B组有较高的两原核细胞（2PN）率和较低的异常受精率、未行授精率,有胚胎可移植周期占总周期的48.19%（40/83）,另3组的实验室结果均较A组好。3微刺激周期中,B组和C组临床妊娠率分别为24.1%和21.6%,其他3组在16.7%-17.8%,但各组差异无统计学意义（P〉0.05）。5组的受精率、异常受精率、优质胚胎率及可移植胚胎率比较,差异均有统计学意义（P〈0.05）。B组的异常受精率较高,达15.4%,可移植胚胎率和优质胚胎率也最高,分别达97.0%和87.8%,E组的可移植胚胎率和优质胚胎率最低,仅为75.8%和58.1%,2组比较差异有统计学意义（均P〈0.01）;C组受精率较低,异常受精率也低,仅为3.0%,与D组及B组比较差异均有统计学意义（均P〈0.01）。结论：取卵时卵泡容积在2.5-5.0 m L,对应h CG日卵泡直径约在15.1-19.6 mm时行IVF-ET/ICSI助孕结局可能较好,但还需扩大样本以获得更为可靠的结论。

Objective： To study the association between the volume size of single follicular and IVF-ET/ICSI outcomes, in which the ultrasound was used to observe the single follicular developmental state in natural cycles and minimal stimulation cycles. Methods：Clinical data of 1 480 women undergoing IVF-ET/ICSI in our center between April 2007 and May 2012 were retrospectively analyzed. They were divided into 5 groups according to the follicular volume size：group A,≥5.5 m L;group B,4.5-5.0 m L,group C,3.5-4.0 m L,group D,2.5-3.0 m L,group E,1.0-2.0 m L. The clinical outcomes were compared. Results： 1 Follicular volume was significantly decreased with the mean diameter of single follicle on the day of h CG administration in 5 groups, in both non-stimulation protocol and minimal stimulation protocol（P〈0.001）. 2In natural cycles,the pregnancy rate and live birth rate were relatively low in group A（11.8%）,while those rates in other four groups were 20.0%-25.0% and 15.8%-20.0%,but there were not significant differences in groups（P 〉0.05）. In group A,the available transplantation embryo rate was high while the non-fertilization rate was low; the zero oocyte retrieval rate（32.6%） was higher than those in group C and group D（P〈0.01）; the available transplantation embryo cycle was merely 39.53%（17/43）. In group B,the 2PN rate was high while the abnormal fertilization and the not-done fertilization rate were low; the non-fertilization rate was relative high while the available transplantation embryo cycle was merely 48.19%（40/83）. The results of other C groups were better than group A generally. 3 In minimal stimulation cycles,the pregnancy rates were high in group B and C（24.1% and 21.6%）,but there were not significant differences when compared with three other groups（16.7%-17.8%,P 〉0.05）. There were significant differences in the rates of fertilization,abnormal fertilization,good embryo and available transplantation embryo among five groups（P 〈0.05）. The abnormal fertilization rate in group B was relatively high（15.4%） and the available transplantation embryo rate and the good embryo rate were highest（97.0% and87.8%,respectively）. The good embryo rate and the available transplantation embryo rate in group E were lowest（58.1% and 75.8%,respectively,P〈 0.01）. The fertilization rate in group C was lowest and the abnormal fertilization rate was also lowest（3.0%,P〈0.01）. Conclusions：IVF-ET/ICSI outcomes may be better when the volume of single follicle was 2.5-5.0 m L（15.1-19.6 mm of oocyte diameter）. However, it is necessary to have more well-designed and multicenter studies.