超排卵周期卵巢反应性与体外受精、卵胞浆内单精子注射结局的关系

Impact of high response of ovary to gonadotropin stimulation on the outcome of in vitro fertilization and embryo transfer or intracytoplasmic sperm injection

目的 探讨超排卵周期中卵巢反应性与体外受精 (IVF)、卵胞浆内单精子注射 (ICSI)结局的关系。方法 回顾分析 1999年 3月至 2 0 0 0年 12月间 ,4 74对不孕夫妇在本中心按常规方法行IVF 胚胎移植 (ET)及ICSI治疗的 5 10个周期。采用促性腺激素释放激素激动剂 (GnRH a) 高纯促卵泡激素 (FSH HP) 人绒毛膜促性腺激素 (hCG)长、短方案促排卵 ,以注射hCG日血清雌二醇 (E2 ) >110 10pmol L(16 0个周期 )为A组 ,获卵数 >15个 (14 8个周期 )为B组 ,A、B两组为卵巢高反应组 ;E2≤ 110 10pmol L(35 0个周期 )为C组 ,获卵数≤ 15个 (36 2个周期 )为D组 ,C、D两组为正常反应组。结果 高反应组与低反应组间 ,年龄、不孕时间、基础FSH水平及FSH用量差异有显著性 (P <0 0 1,P <0 0 5 )。A组着床率、妊娠率分别为 18 9% (94 4 98)与 38 8% (6 2 16 0 ) ,C组分别为 2 0 7% (2 12 10 2 6 )与4 1 4 % (14 5 35 0 ) ,两组比较 ,差异无显著性 (P >0 0 5 ) ;B组分别为 2 2 5 % (10 3 4 5 7)与 4 6 6 % (6 9 14 8) ,D组分别为 19 0 % (2 0 3 10 6 7)与 38 1% (138 36 2 ) ,两组比较 ,差异无显著性 (P >0 0 5 )。卵巢过度刺激综合征 (OHSS)发生率 ,A组为 6 9% (11 16 0 ) ,C组为 2 6 % (9 35 0 ) ,B组为 8 1% (

Objective To evaluate the impact of elevated peak estradiol(E 2) levels and a high number of retrieved oocytes on implantation and pregnancy rate in patients undergoing in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI). Methods Retrospectively analyzed 474 infertile women undergoing 510 cycles for IVF-ET/ICSI treatment during the period of March 1999 to December 2000. Using a standard long protocol/ flare-up protocol [(gonadotropic hormone releasing hormone agonist/high pure follicle-stimulating hormone (FSH-HP)/human chorionic gonadotropin (hCG)] for ovarian stimulation. High responders were defined as those who had peak E 2 levels of >11 010 pmol/L on the day of hCG administration ( n =160) or >15 retrieved oocytes ( n =148). Normal responders were defined as those who had peak E 2 levels of ≤11 010 pmol/L on the day of hCG administration ( n =350) or ≤15 retrieved oocytes ( n =362). Results There were statistically significant differences in age, infertile years, basal FSH level and the ampules of FSH-HP required between high and normal responders ( P <0.01 and P <0.05). Ovarian hyperstimulation syndrome (OHSS) increased significantly in the high responders ( P <0.01). There were no statistically significant differences in implantation rate or pregnancy rate between high and normal responders. Conclusion Elevated peak E 2 levels and high oocytes retrieved were not detrimental to IVF outcome, but had high incidence of OHSS.