黄体期长效长方案中HCG扳机日最大卵泡直径对妊娠结局的影响

Effect of maximal follicular diameter of HCG trigger day on pregnancy outcome in long-acting long-term protocol used in luteal phase

目的探究黄体期长效长方案中HCG扳机日适合的最大卵泡直径。方法根据HCG扳机日最大卵泡直径分为A组(≥17mm且≤19mm)、B组(>19mm且≤21mm)、C组(>21mm),分析三组之间一般基础资料、促排卵治疗数据、胚胎实验室数据(包括受精及胚胎培养)、胚胎移植及妊娠结局。结果C组Gn总天数、Gn总量显著大于A、B两组(P<0.05);A组受精数、2PN数、2PN率、2PN卵裂数、优胚数、囊胚数、囊胚形成率显著高于C组(P<0.05),C组2PN卵裂率显著高于B组(P<0.05);所有首次移植周期总的临床妊娠率及新鲜移植周期临床妊娠率C组均显著高于A、B组(P<0.05),而冻融移植周期临床妊娠率各组间无统计学差异(P>0.05);各组间所有首次移植周期、新鲜移植周期、冻融移植周期的活产率、早期流产率、晚期流产率、足月产率、早产率和多胎率均无统计学差异(P>0.05)。结论黄体期长效长方案中HCG扳机日最大卵泡直径大于21mm时,在新鲜移植周期能获得最高的临床妊娠率;而在17~19mm时,有较高妊娠率的同时也能获得较多的冷冻储存胚胎数。

Objective:To explore the suitable maximal follicular diameter on HCG trigger day in the long-acting long-term protocol used in luteal phase.Methods:The cycles were divided into three groups according to the maximal follicular diameter on HCG trigger day:group A(≥17 mm and≤19 mm),group B(>19 mm and≤21 mm)and group C(>21 mm).The clinical baseline data,ovulation induction treatment data,laboratory embryo data(fertilization and embryo culture),embryo transfer and pregnancy outcome were compared among the three groups.Results:Total days and total doses of Gn used in group C were significantly more than those in group A and group B(P<0.05).The fertilization number,2PN number,2PN rate,2PN cleavage number,good quality embryo number,blastocyst number,blastocyst formation rate in group A were significantly higher than those in group C(P<0.05).The 2PN cleavage rate in group C was significantly higher than that in group B(P<0.05).The total clinical pregnancy rate of all the first transplantation cycles and the clinical pregnancy rate of fresh transplantation cycles in group C were significantly higher than those in group A and B(P<0.05).However,there was no significant difference in clinical pregnancy rate in the frozen-thawed cycles(P>0.05).There were no significant differences in live birth rate,early abortion rate,late abortion rate,full-term delivery rate,premature delivery rate,and multiple pregnancy rate among the all first transfers cycles,the fresh transplant cycles and the frozen-thawed cycles.Conclusions:In the long-acting long-term protocol used in luteal phase,when the maximal follicle diameter on the HCG trigger day is larger than 21 mm,the highest clinical pregnancy rate can be obtained in the fresh cycle.When maximal follicle diameter is 17-19 mm,the higher pregnancy rate and more frozen embryos can be obtained.