人绒毛膜促性腺激素注射日血清孕酮水平上升对妊娠结局的影响及影响因素研究

Study on the effect of increase of serum progesterone level on the day of h CG injection on pregnancy outcomes and the influencing factors

目的探讨人绒毛膜促性腺激素(h CG)注射日血清孕酮(P)水平上升对妊娠结局的影响,分析影响因素。方法选取2017年1-12月在绵阳市中心医院进行体外受精-胚胎移植(IVF-ET)的106例患者为研究对象,根据h CG注射日血清P水平分为升高组(48例)和未升高组(58例)。比较两组患者的年龄、体质量指数、基础血清卵泡刺激素(FSH)水平、基础血清黄体生成素(LH)水平、基础血清P水平、促性腺激素(Gn)启动剂量、Gn总用量,h CG注射日的血清LH、雌二醇(E2)水平与卵泡数,妊娠结局(正常受精率、胚胎着床率、生化妊娠率、临床妊娠率、流产率)。分析h CG注射日血清P水平升高的影响因素。结果两组患者h CG注射日的血清LH、E2水平与卵泡数比较,差异均有统计学意义(均P<0.05)。两组患者正常受精率、生化妊娠率、流产率比较差异均无统计学意义(均P>0.05);升高组患者胚胎着床率与临床妊娠率均显著低于未升高组(均P<0.05)。基础血清P水平、h CG注射日血清E2水平与h CG注射日卵泡数为血清P水平升高的影响因素(P<0.05)。结论h CG注射日血清P水平升高不利于妊娠结局,临床可通过促排卵前评估卵巢反应、积极监测基础血清P水平等措施进行应对,以改善IVF-ET患者的妊娠结局。

Objective To explore the effect of increase of serum progesterone ( P) level on the day of human chorionic gonadotropin ( hCG) injection on pregnancy outcomes,analyze the influencing factors. Methods A total of 106 patietns treated by in vitro fertilization- embryo transfer ( IVF-ET) in Mianyang Central Hospital from January to December in 2017 were selected and divided into increased P group ( 48 patients) and non-increased P group ( 58 patients) according to the level of serum P on the day of hCG infection. Age,BMI,basal ser- um follicle-stimulating hormone ( FSH) levels,basal serum luteinizing hormone ( LH) levels,basal serum P levels,starting doses of gona- dotropin,the total dosages of Gn,serum LH,estradiol ( E2 ) levels and the numbers of follicles on the day of hCG injection,pregnancy out- comes ( normal fertilization rates,embryo implantation rates,biochemical pregnancy rates,clinical pregnancy rates,abortion rates) in the two groups were compared. The influencing factors of increase of serum P level on the day of hCG injection were analyzed. Results There were statistically significant differences in serum LH,E2 levels and the number of follicles on the day of hCG injection between the two groups ( P<0. 05). There was no statistically significant difference in normal fertilization rate,biochemical pregnancy rate,and abortion rate be- tween the two groups ( P>0. 05). Embryo implantation rate and clinical pregnancy rate in increased P group were statistically significantly lower than those in non-increased P group ( P<0. 05). Basal serum P level,E2 level and the number of follicles on the day of hCG injection were the influencing factors of increase of serum P level on the day of hCG injection ( P<0. 05). Conclusion The increase of serum P level on the day of hCG injection has adverse impact on pregnancy outcomes. Evaluation of ovarian response before ovulation and active monitoring of basic serum P level can improve pregnancy outcomes of IVF-ET patients.