早期血清β-hCG对卵裂期胚胎或囊胚移植后妊娠结局的预测

Predictive Value of Early Serum Beta-Human Chorionic Gonadotropin Measurements After Cleavage or Blastocyst Embryo Transfers

【目的】比较卵裂期胚胎及囊胚移植后早期血清β-人绒毛膜促性腺激素(β-h CG)对体外受精-胚胎移植(IVF-ET)妊娠结局的预测作用。【方法】回顾性分析自2010年6月至2015年5月共2 421个在本中心行IVF-ET后临床确认宫内单胎妊娠的患者周期的数据。比较分析卵裂期胚胎移植后14 d的血清β-h CG值及囊胚移植后12 d的血清β-h CG值与妊娠结局的关系。【结果】对于临床确认宫内妊娠的患者,囊胚移植组的早期β-h CG水平高于卵裂期胚胎移植组(687 U/L vs503 U/L)。根据妊娠结局分组后,这种差异同样存在于自然流产、继续妊娠(OP)及活产(LB)的患者中。根据新鲜或冷冻移植分组后,这种差异仅在冷冻移植组中有统计学意义。对于冷冻卵裂期胚胎移植的患者,以β-h CG>475 U/L作为活产的预测值(灵敏度79.0%,特异度61.3%)。对于冷冻囊胚移植的患者,以β-h CG>575 U/L作为活产的预测值(灵敏度74.9%,特异度59.2%)。【结论】冷冻移植周期中,囊胚移植的早期血清β-h CG值高于卵裂期胚胎。移植胚胎时期不同,应用早期血清β-h CG值预测妊娠结局的预测值也不同。囊胚或卵裂期胚胎移植后的早期血清β-h CG值均能有效预测活产结局。

【Objective】To compare early serum beta-human chorionic gonadotropin(β-h CG) levels after cleavage or blastocystembryo transfers(ET) in predicting pregnancy outcome.【Methods】A total of 2 421 IVF-ET cycles in our center performed from June2010 to May 2015 and resulted in clinical intrauterine pregnancies were analyzed retrospectively. The predictive value was comparedbetween β-h CG on day 14 after cleavage ET and β-h CG on day 12 after blastocyst ET.【Results】Serum β-h CG levels of patients re-sulted in clinical intrauterine pregnancies were significantly higher with blastocyst ET compared with cleavage ET. This significant dif-ference was also existed in patients resulted in miscarriage, ongoing pregnancy(OP) or live birth(LB). However, this significant differ-ence was only existed in frozen embryo transfers. For a frozen cleavage ET, the cut-off value was 475 U/L(sensitivity 79%, specificity61.3%) in predicting LB. For a frozen blastocyst ET, the cut-off value was 575 U/L(sensitivity 74.9%, specificity 59.2%) in predictingLB.【Conclusion】In frozen embryo transfers, early serum β-h CG level after blastocyst ET is higher than cleavage ET. The cut-off val-ue in predicting pregnancy outcome is different according to the stage embryo transferred. Early serum β-h CG can effectively predictlive birth after blastocyst or cleavage ET.