卵泡期超长方案HCG日雌激素水平对临床结局的影响

目的分析卵泡期超长方案HCG日雌激素水平对体外受精一胚胎移植（IVF—ET）临床结局的影响。方法回顾性分析2016年1月至12月643例患者的IVF-ET周期的临床资料，根据HCG日E2水平分组：E2≤2000pg／ml（I组，n=366），2000pg／ml〈E2 4000pg／ml（II组，n=242），4000pg／ml〈E2≤5000pg／ml（RI组，n=21），E2〉5000pg／ml（Ⅳ组，n=14），比较四组促排卵情况及临床结局。结果HCG日孕酮水平Ⅰ组明显低于Ⅱ组、Ⅲ纽和Ⅳ纽（P〈0．05）；Gn使用总量随E2水平升高呈下降趋势，Ⅱ组、Ⅳ组明显低于I纽（P〈0．05）；获卵数随着E2水平升高而增多，Ⅰ组明显低于Ⅱ组、Ⅲ组和Ⅳ组（P〈0．05）。优胚率Ⅱ组低于I组（P〈005）。Ⅲ组种植率67．7％，明显高于Ⅰ组和Ⅱ组（P〈0．05），临床妊娠率Ⅰ组：56．6％，Ⅱ组：56．2％，Ⅲ组：8I．0％，Ⅳ组：50．0％），早期流产率（I组：9．2％，Ⅱ组：6．6％，Ⅲ组：5．9％，Ⅳ组：O％）In组临床妊娠率高，流产率低，但差异无统计学意义。四组重度OHSS发生率差异无统计学意义。结论卵泡期超长方案中雌激素水平升高可能一定程度改善种植率，高雌激素水平对胚胎质量和临床妊娠率，早期流产率并未产生不利影响。

Objective To analyze the impact of serum estradiol levels on the hCG administration day on the clinical outcome following in vitro fertilization cycles with GnRH analogue protocols. Methods A retrospective analysis of 643 cases of IVF-ET cycle were conducted from January 2016 to December 2016 in the second hospital affxliated to Wenzhou medical university reproductive center.All of the cycles were divided into four groups according to serum estradiol levels on the hCG administration day： group I E2≤2000pg/ml （ n=366 ） , group Ⅱ 2000〈E2≤4000pg/ml （ n=242 ） , group Ⅲ 4000〈E2≤5000pg/ml （ n=21 ） , group ⅣE2〉5000pg/ml （ n=14 ） , COH condition and clinical outcome were compared in this four groups. Results Higher progesterone level in group I than the other groups on hCG administration day （ P〈0.05 ） ; Gn usage turns decreased with the increase of serum estradiol levels, Gn usage of group Ⅱ and groupIV was much lower than group I （P〈0.05） .Retrieved ooeytes number increased with the increase of serum estradiol levels, specifically group I was significantly lower than the other groups （P〈0.05） . The optimal embryo rate in group Ⅱ was lower that in group I （ P〈0.05 ） .Group Ⅲ showed the highest implantation rate was 67.7%, that was significantly higher than that of group I and group Ⅱ （ P〈0.05 ） . he highest clinical pregnancy rate and low abortion rate were found in group Ⅲ, but there was no statistical difference, so as the incidence of severe OHSS in four groups. Conclusion The increase of estrogen level may improve the implantation rate to a certain extent with GnRH analogue protocols in follicular phase, and high estrogen level has no adverse effect on embryo quality, clinical pregnancy rate and early abortion rate.