三种不同促排卵方案HCG日雌二醇水平和获卵数与妊娠结局的相关性分析

Comparison of E2level on HCG day and number of retrieved oocytes and pregnancy outcomes in three different stimulation protocols

目的研究3种不同促排卵方案中HCG日E 2水平和获卵数的比值与IVF-ET妊娠结局的关系。方法回顾性分析2018年1~8月在我中心行IVF/ICSI治疗的639例患者的临床资料,其中长方案444例,超长方案104例,拮抗剂方案91例,比较3种不同方案患者IVF/ICSI的临床参数和妊娠结局。结果拮抗剂方案的Gn天数、Gn用量、受精数、培养胚胎数及形成囊胚数显著低于长方案组和超长方案组(P<0.05);超长方案组胚胎移植(ET)日内膜厚度和着床率显著高于长方案组和拮抗剂方案组(P<0.05);长方案组HCG日E 2水平显著高于超长方案组和拮抗剂方案组(P<0.05);3组的获卵数和HCG日E 2/获卵数情况分别为:超长方案组>长方案组>拮抗剂方案组;长方案组>超长方案组>拮抗剂方案组,差异均有统计学意义(P<0.05)。而3组间囊胚形成率、受精率、妊娠率及流产率比较均无统计学差异(P>0.05)。ROC曲线与逻辑回归分析表明:长方案和拮抗剂方案组HCG日E 2水平可作为妊娠率的阳性预测因素(P<0.05),但不同促排卵方案HCG日E 2/获卵数与妊娠率无显著相关性(P>0.05)。结论虽然3种不同促排卵方案的获卵数、HCG日E 2和HCG日E 2/获卵数等有所不同,但其具有相似的临床结局,且长方案和拮抗剂方案HCG日E 2水平可作为妊娠率的阳性预测因素,而3组促排卵方案中HCG日E 2/获卵数对预测妊娠结局无显著意义。

Objective:To study the correlation between the ratio of E 2 level on HCG day/number of oocytes retrieved and the IVF-ET pregnancy outcome in three different stimulation protocols.Methods:The clinical data of 639 infertile women undergone IVF/ICSI treatment,including 444 long protocol,104 super-long protocol,and 91 antagonist protocol,in our hospital from January to August 2018 were retrospectively analyzed.The clinical parameters and pregnancy outcomes of patients were compared among the three different protocols.Results:The gonadotropin(Gn)days,the dose of Gn,number of fertilization,number of embryos cultured and number of blastocyst formed in antagonist protocol were significantly lower than those in long protocol and super-long protocol group(P<0.05).The thickness of endometrium on embryo transfer day and implantation rate in the super-long protocol group were significantly higher than those in the long protocol group and the antagonist protocol group(P<0.05).The E 2 level on HCG day in the long protocol group was significantly higher than those in the super-long protocol and the antagonist protocol(P<0.05).The number of oocytes retrieved in the three groups was ranked as:super-long protocol>long protocol>antagonist protocol.The ratio of E 2 level on HCG day/number of oocytes retrieved was ranked as:long protocol>super-long protocol>antagonist protocol.All the differences were significant(P<0.05).However,there was no significant difference in blastocyst formation rate,fertilization rate,pregnancy rate and abortion rate among the three stimulation protocols(P>0.05).The ROC curve and logistic regression analysis showed that E 2 level on HCG day was a positive predictor of pregnancy rate in long protocol group and antagonist protocol group(P<0.05),but the ratio of E 2 level on HCG day/number of oocytes retrieved was not significantly correlated with the pregnancy outcome in either group(P>0.05).Conclusions:The number of oocytes retrieved,E 2 level on HCG day and the ratio of E 2 level on HCG day/number of retrieved oocytes are different among the three stimulation protocols,but they have similar clinical outcomes.Moreover,the E 2 level on HCG day can be used as a positive predictor of pregnancy rate in long protocol and antagonism protocol group.The ratio of E 2 level on HCG day/number of oocytes retrieved cannot predict the pregnancy rate in all the three protocols.