人绒毛膜促性腺激素注射前血清孕激素升高的持续时间对体外受精-胚胎移植的影响

Negative Effect of Elevated Progesterone before h CG Administration on Outcome of in vitro Fertilization

目的:探讨在控制性促排卵(COS)过程中人绒毛膜促性腺激素(h CG)注射前孕激素水平升高的持续时间对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法:选取2012年1月—2014年12月在安徽医科大学附属省立医院生殖医学中心行IVF-ET或胞浆内单精子注射(ICSI)-ET助孕的1 132例不孕症患者的临床资料。根据h CG注射日血清孕激素水平分4组:A1组h CG注射日孕激素水平<3.18 nmol/L,共521例;A2组h CG注射日孕激素水平3.18~6.36 nmol/L,共338例;A3组h CG注射日孕激素水平>6.36~7.95 nmol/L,共197例;A4组h CG注射日孕激素水平>7.95 nmol/L,共76例。根据h CG注射前(包括h CG注射日及前一日)血清孕激素水平持续2天在同一范围的患者分为3组:B1组孕激素水平<3.18 nmol/L,共220例;B2组孕激素水平3.18~6.36 nmol/L,共116例;B3组孕激素水平>6.36 nmol/L,共62例。对上述各组的临床资料进行回顾性分析,比较各组患者的促排卵效果及周期妊娠结局。结果:h CG注射日不同孕激素水平的4组患者年龄、不孕年限、促性腺激素(Gn)天数、Gn用量、获卵数、正常受精率、可移植胚胎率和优质胚胎率的比较差异均无统计学意义(均P>0.05)。A4组与A1组比较,胚胎种植率、生化妊娠率、临床妊娠率和活产率差异均具统计学意义(均P<0.008)。与B1组相比,B2组和B3组的胚胎种植率、临床妊娠率及活产率下降,差异有统计学意义(均P<0.017),B3组的生化妊娠率也比B1组低,差异有统计学意义(P<0.017)。结论:COS过程中,h CG注射日孕激素水平>7.95 nmol/L及h CG注射前连续2天孕激素水平≥3.18 nmol/L对IVF-ET的妊娠结局具有负面影响。

Objective：To explore the impact of the elevated level of serum progesterone before h CG administration on the pregnancy outcome of in vitro fertilization during controlled ovarian stimulation（COS）.Methods：The data of 1 132 infertile patients underwent IVF-ET or ICSI-ET treatment from January 2012 to December 2014 in Anhui Provincial Hospital Affiliated to Anhui Medical University were retrospectively analyzed.Those objectives were firstly divided into four groups according to their progesterone levels on the day of h CG administration, group A1： progesterone 〈3.18 nmol/L（521 cases）; group A2： progesterone 3.18-6.36 nmol/L（338cases）; group A3： progesterone 〉6.36-7.95 nmol/L（197 cases）; group A4： progesterone 〉7.95 nmol/L（76 cases）.According to the serum progesterone level that maintained 2 days before h CG administration（including the day of h CG injection and the previous day）, those patients were secondly divided into three groups, group B1： progesterone〈3.18 nmol/L for two days（220 cases）; group B2： progesterone 3.18-6.36 nmol/L for two days（116 cases）; group B3： progesterone 〉6.36 nmol/L for two days（62 cases）. The clinical data and the outcomes of IVF/ICSI-ET were compared among those groups. Results：There were no significant differences in the age, the duration of infertility,the total dose of gonadotropin, the gonadotropin days, the number of oocyte retrieval, the normal fertilization rate,the available embryo rate and the high-quality embryo rate among the groups（P〉0.05）. Compared with the group A1, thebiochemical pregnancy rate, implantation rate, clinical pregnancy rate and live-birth rate in the group A4 were significantly reduced（P〈0.008）. The implantation rate, clinical pregnancy rate and live-birth rate in the group B2 and the group B3 were much lower than those in the group B1, while the biochemical pregnancy rate in the group B3 was lower than that in the group B1（P〈0.017）. Conclusions：In controlled ovarian stimulation, there were negative impacts on the outcome of IVF when the progesterone level 〉7.95 nmol/L on the day of h CG administration and the maintained two days of progesterone level ≥3.18 nmol/L before h CG administration.