EOR在预测辅助生殖结局中的作用

A Retrospective Analysis of EOR in Predicting the Outcome of Assisted Reproduction

目的在辅助生殖中评估hCG日雌二醇与获卵数的比值(estradiol oocyte ratio,EOR)在预测治疗结局中的可靠性。方法收集2010年1月至2014年12月在云南省第一人民医院生殖中心就诊的不孕症患者12564例,根据年龄分为3组:<35, 35~39,和≥40岁。在hCG日测量血清中雌二醇浓度,并在取卵日行超声引导取卵术,计算EOR,将样本分为12组。分析获卵数、卵母细胞MⅡ率、正常受精率、卵裂率、持续发育率、优胚率以及最终妊娠结局。统计EOR和其中各项参数之间的关系。结果 (1) hCG日E2水平随着年龄的增加呈下降趋势,而EOR呈上升趋势,随着EOR的上升妊娠率显著下降,差异有统计学意义(P <0.05);<35, 35~39,和≥40岁3组之间临床妊娠率(clinical pregnancy rate, CPR)差异无统计学意义(P>0.05),但年龄较大者,其妊娠率更低;(2)生化妊娠率与临床妊娠率最高的分组为500~550(pg/mL),分别为72.25%,64.32%;(3)获卵数、获卵率随着EOR的增加显著降低,P <0.05,而MⅡ卵母细胞率最大的分组为≥650(pg/mL);(4)常规IVF与ICSI在正常受精率、卵裂率、持续发育率以及优质胚胎率并差异无统计学意义(P>0.05);(5)各组在囊胚形成数、囊胚形成率、优质囊胚数、优质囊胚率等方面均差异无统计学意义。结论 EOR在预测ART结局中有着重要的作用,而且在未来的临床应用中也会有更好的前景。

Objective To evaluate the reliability of EOR（estradiol： oocyte ratio） in predicting the outcome of assisted reproduction. Methods From 2010 to 2014,12564 cases of infertility in the Reproductive Center of the First People＇s Hospital of Yunnan Province were selected and divided into three groups according to their age（35, 35-39, and ≥ 40 years old）. On the day of hCG trigger, the concentration of estradiol in serum were measured. The ratio of estradiol to the number of oocytes was calculated, and the samples were divided into 12 groups according to the EOR value. The relationship between EOR and the following parameters： oocyte retrieval number,oocyte MⅡ rate,normal fertilization rate,cleavage rate,sustained development rate,high qualified embryo rate and outcome of pregnancy were statistically analyzed. Results（1） On the day of hCG trigger,the serum estradiol（E2） levels showed a downward trend with the increase of age,while EOR showed an upward trend. With the increasing of EOR, the pregnancy rate was significantly decreased（P〈0.05）. Clinical pregnancy rate（CPR）between the three age groups had no significant difference,but older women showed a lower pregnancy rate trend.（2） The highest biochemical pregnancy rate and clinical pregnancy rate was in the group of 500-550（pg/mL）,respectively,72.25% and 64.32%.（3） The number of oocytes retrieved and oocyte retrieved rate were significantly decreased with the increasing of EOR（P〈0.05）. The group of highest oocyte MⅡ rate was ≥650（pg/mL）.（4） In conventional IVF and ICSI, with increasing EOR, the normal fertilization rate deavage rate, sustained development rate and high qualified embryo rate had no significant difference.（5） There were no significant differences in the number of blastocyst formation, the rate of blastocyst formation, the number of high-quality blastocyst and the rate of high quality blastocyst in each EOR group. Conclusions EOR plays an important role in predicting the outcome of ART and there will be a better prospect in future clinical applications.