长方案及拮抗剂方案中HCG日孕酮水平对IVF-ET妊娠结局的影响

Effect of progesterone level on HCG day on outcomes of IVF cycle with GnRH agonist or GnRH antagonist protocol

目的探讨IVF-ET促排卵过程中HCG日孕酮水平对IVF结局的影响。方法回顾性分析2008年6月至2015年4月我中心行IVF-ET助孕的1 611个周期,其中长方案IVF 1 264个周期,拮抗剂方案IVF 347个周期;两种方案的患者均根据HCG日孕酮(P)水平分为三组:A组P≤0.62nmol/L;B组0.62nmol/L<P≤4.68nmol/L;C组P>4.68nmol/L。比较各组间促排卵及妊娠结局。结果长方案与拮抗剂方案HCG日孕酮水平及HCG日孕酮>4.68nmol/L的发生率均无统计学差异(P>0.05);无论是长方案还是拮抗剂方案,A组的>14mm卵泡数、HCG日E2水平及获卵数均显著低于B组及C组(P<0.001),而成熟卵率、受精率及优胚率各组间均无统计学差异(P>0.05);两种方案中,各组间临床妊娠率均无统计学差异(P>0.05),但B组的活产率显著高于C组(P<0.05)。结论长方案及拮抗剂方案HCG日孕酮升高的发生率相似;HCG日P水平过高或者过低都对IVF的妊娠结局有影响,过高对妊娠结局的影响更大。

Objective： To explore the effect of progesterone level on HCG day on the outcome of IVF cycles with GnRH agonist or GnRH antagonist protocol. Methods= The data of 1 611 IVF cycles performed in our hospital from June 2008 to April 2015 were analyzed. There were 1 264 GnRH agonist cycles and 347 GnRH antagonist cycles. According to serum progesterone level on the HCG day, the patients were divided into three groups in the cycles with two protocols respectively, group A≤0.62 nmol/L, group B between 0.62 nmol/L to 4.68 nmol/L, group C 〉4.68 nmol/L. The clinical outcomes were compared among the groups. Results. The progesterone levels and the ratio of progesterone levels more than 4.68 nmol/L were not significantly different between GnRH-agonist and GnRH-antagonist cycles （P〉 0.05）. The estrogen levels on HCG day, number of follicle more than 14 mm, number of oocytes retrieved in group A were significantly less than those in group B or group C （P〈0. 001）. The mature oocyte rate, fertilization rate and high quality embryo rate were not significantly different among the three groups （P〉 0.05）. The pregnancy rate were not significantly different among the three groups （P〉0.05）, but the live birth rate in group B was significantly higher than that in group C（P〈0.05）. Conclusions. The occurrence of increased progesterone level on HCG day was similar between GnRH agonist cycles and GnRH-antagonist cycles. Too high or too low progesterone level have impact on the outcomes of IVF, especially too high progesterone level has greater influence.