不同促排卵方案中雌激素和孕激素对妊娠结局的影响研究

Serum estradiol, progesterone levels and pregnancy outcomes in different stimulating ovulation protocols

目的探讨不同促排卵方案中雌激素和孕激素水平及其比值对妊娠结局的影响。方法回顾性分析不孕患者64例(80个促排卵周期),其中19例(24个促排卵周期)应用枸橼酸氯米芬(CC)促排卵(CC组),17例(23个促排卵周期)应用CC+注射用尿促性腺激素(HMG)促排卵(CC+HMG组),18例(20个促排卵周期)应用HMG促排卵(HMG组),10例(13个促排卵周期)应用来曲唑(LE)促排卵(LE组)。比较4组患者妊娠率,人绒毛膜促性腺激素(HCG)注射日(HCG日)血清雌二醇(E_2)、孕酮(P)及P/E_2;比较妊娠患者与未妊娠患者HCG日血清E_2、P水平及P/E_2。结果 CC+HMG组、HMG组患者妊娠率(47.1%、44.7%)均较CC组患者(10.5%)高。4组患者间HCG日血清E_2水平两两比较差异均有统计学意义(均P<0.05)。CC+HMG组、HMG组、LE组患者血清P水平均高于CC组(均P<0.05),CC+HMG组高于HMG组(P<0.05)。LE组患者HCG日P/E_2与CC组、CC+HMG组、HMG组比较差异均有统计学意义(均P<0.05)。妊娠患者与未妊娠患者HCG日血清E_2、P水平及P/E_2比较差异均无统计学意义(均P>0.05)。结论 HMG的参与可使雌激素和孕激素达到利于胚胎发育和子宫内膜容受性同步的水平,合适的雌激素和孕激素水平及其比值利于妊娠成功。

Objective To investigate the estradiol(E2),progesterone(P)levels and progesterone/estradio(P/E2)ratio in different stimulating ovulation protocols and the correlation with pregnancy outcomes.Methods Sixty-six infertility women with80stimulating ovulation cycles were recruited in the study,including19cases(24cycles)using clomiphene citrate for stimulating(CC group),17cases(23cycles)using CC+menotrophin injection(CC+HMG group),18cases(20cycles)using HMG(HMG group),and10cases(13cycles)using letrozole(LE group).The pregnancy rates were documented and compared among4groups.The E2,P levels and P/E2ratio at HCG day were measured and compared among4groups and between pregnant and non-pregnant groups.Results The pregnancy rates in HMG and CC+HMC groups were significantly higher than that in CC group(47.1%,44.7%vs.10.5%,P<0.05).There were significant differences in serum E2levels at HCG day among different groups(all P<0.05).Compared to CC group,the serum P levels at HCG day were significantly higher in CC+HMG,HMG and LE groups(all P<0.05),while the level in CC+HMG group was higher than that in HMG group(P<0.05).The P/E2ratios in CC,CC+HMG and HMG groups were significantly different to that in LE group,(all P<0.05).There was no statistically significant difference in the serum E2,P levels and P/E2at HCG day between pregnant and non-pregnant women(all P>0.05).Conclusion HMG protocol may produce better E2and P levels in stimulating ovulation,which are beneficial for the embryo development and endometrial receptivity leading to the success of pregnancy.