探讨血清孕酮及雌二醇水平对妊娠结局的影响

Influence of serum progesterone and estradiol levels on pregnancy outcome

目的探讨自然周期成熟卵泡排卵前孕酮(P)及雌二醇(E_(2))水平的变化对妊娠结局的影响以期改善自然周期人工授精的妊娠结局。方法170例自然周期人工授精助孕患者,根据宫腔内人工授精(IUI)日E_(2)水平分为1组(110例,106 pg/ml≤E_(2)<312 pg/ml)、2组(52例,312 pg/ml≤E_(2)<518 pg/ml)、3组(8例,518 pg/ml≤E_(2)<722 pg/ml);根据IUI日P水平分为A组(98例,P≤1 ng/ml)、B组(56例,1.0 ng/ml<P≤1.5 ng/ml)、C组(16例,P>1.5 ng/ml)。观察比较各组IUI日促黄体生成素(LH)、E_(2)、P水平、卵泡直径、内膜厚度及临床妊娠率。结果2组和3组IUI日E_(2)水平高于1组,3组IUI日E_(2)水平高于2组,差异均具有统计学意义(P<0.05);1组IUI日P水平为(1.0±0.2)ng/ml,高于2组和3组的(0.9±0.4)、(0.8±0.4)ng/ml,差异具有统计学意义(P<0.05)。B组和C组IUI日P水平高于A组,C组IUI日P水平高于B组,差异均具有统计学意义(P<0.05);A组IUI日E_(2)水平为(310.2±103.8)pg/ml,高于B组和C组的(265.6±108.4)、(265.0±100.8)pg/ml,差异具有统计学意义(P<0.05)。结论自然周期单卵泡发育过程中,排卵前较低P水平(P≤1.0 ng/ml)及适当的E_(2)水平(312~518 pg/ml)行IUI的临床妊娠率较佳,但这一结论仍需更多样本量支持。

Objective To investigate the effect of progesterone(P)and estradiol(E_(2))levels changes before ovulation of mature follicles in natural cycle on pregnancy outcome,so as to improve the pregnancy outcome of artificial insemination in natural cycle.Methods A total of 170 cases of natural cycle artificial insemination assisted fertility patients were divided into group 1(110 cases,106 pg/ml≤E_(2)<312 pg/ml),group 2(52 cases,312 pg/ml≤E_(2)<518 pg/ml)and group 3(8 cases,518 pg/ml≤E_(2)<722 pg/ml)according to E_(2) level on intrauterine insemination(IUI)day;they were divided into group A(98 cases,P≤1.0 ng/ml),group B(56 cases,1.0 ng/ml<P≤1.5 ng/ml)and group C(16 cases,P>1.5 ng/ml)according to P level on IUI day.The luteinizing hormone(LH),E_(2) and P levels on IUI day,follicle diameter,intimal thickness and clinical pregnancy rate of each group were observed and compared.Results The E_(2) levels on IUI day of group 2 and group 3 were higher than that of group 1,and group 3 was higher that group 2.All the difference was statistically significant(P<0.05).The P level on IUI day of group 1 was(1.0±0.2)ng/ml,which was higher than(0.9±0.4)and(0.8±0.4)ng/ml of group 2 and group 3,and the difference was statistically significant(P<0.05).The P levels on IUI day of group B and group C were higher than that of group A,and group C was higher than group B.All the difference was statistically significant(P<0.05).The E_(2) level on IUI day of group A was(310.2±103.8)pg/ml,which was higher than(265.6±108.4)and(265.0±100.8)pg/ml of group B and group C,and the difference was statistically significant(P<0.05).Conclusion During the development of a single follicle in the natural cycle,a lower P level(P≤1.0 ng/ml)before ovulation and an appropriate E_(2) level(312-518 pg/ml)have a better clinical pregnancy rate for IUI,but this conclusion is still needed more sample size support.