扳机日每成熟卵泡血清雌二醇水平对早卵泡期长方案IVF-ET妊娠结局的影响

Effect of serum estradiol level per mature follicle on trigger day on pregnancy outcome of IVF-ET with GnRH agonist long protocol in early follicular phase

目的分析早卵泡期长方案鲜胚移植周期中,扳机日每成熟卵泡血清雌二醇(E_(2))水平对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法回顾性分析2019年1月到2021年4月在武汉大学人民医院行早卵泡期长效长方案的586个IVF-ET周期的临床资料,根据扳机日E_(2)与≥14 mm卵泡数量的比值(E_(2)/fol)分为3组:A组(E_(2)/fol≤550.5 pmol/L)110个周期、B组(550.5 pmol/L<E_(2)/fol≤917.5 pmol/L)275个周期和C组(E_(2)/fol>917.5 pmol/L)201个周期,比较各组间的促排情况、实验室参数及临床结局。结果3组间Gn启动剂量、Gn总量、Gn使用天数、扳机日子宫内膜厚度及≥14 mm卵泡数均无显著性差异(P>0.05),扳机日E_(2)、LH、P水平C组显著高于A、B组,B组显著高于A组(P<0.05)。3组间获卵数、MⅡ卵率、受精方式、优质胚胎数、2PN受精率、卵裂率、优质胚胎率、平均移植胚胎数均无显著性差异(P>0.05)。C组的囊胚形成率显著低于B组(56.2%vs.60.7%,P<0.05),高评分囊胚率显著低于A、B组(19.7%vs.24.8%、24.5%,P<0.05);D3胚胎移植比例A、B组显著高于C组(64.5%、61.1%vs.46.3%,P<0.05)。3组间临床妊娠率和胚胎种植率随E_(2)/fol值增高呈逐渐下降趋势(分别为66.4%vs.61.5%vs.56.7%,49.7%vs.45.5%vs.42.2%),但差异尚无统计学意义(P>0.05);A组HCG阳性率显著高于C组(80.9%vs.70.1%,P<0.05);3组间流产率、多胎率均无显著性差异(P>0.05)。结论早卵泡期长效长方案鲜胚移植周期中,每成熟卵泡血清E_(2)水平不影响IVF获卵数、胚胎质量和临床妊娠率,但适当低水平的E_(2)/fol可能具有更高的优质囊胚形成率和HCG阳性率。

Objective:To analyze the effect of serum estradiol(E_(2))level per mature follicle on trigger day on pregnancy outcome of IVF-ET with GnRH agonist long protocol in early follicular phase.Methods:The clinical data of 586 IVF-ET cycles with long-acting GnRH agonist long protocol in early follicular phase in Renmin Hospital of Wuhan University from January 2019 to April 2021 were retrospective analyzed.According to the ratio between E_(2) and the number of follicles≥14 mm(E_(2)/fol)on the trigger day,the cycles were divided into three groups:group A(E_(2)/fol≤550.5 pmol/L),group B(550.5 pmol/L<E_(2)/fol≤917.5 pmol/L)and group C(E_(2)/fol>917.5 pmol/L).The status of ovulation induction,laboratory parameters and clinical outcomes were compared among the groups.Results:There were no significant difference in the number of obtained oocytes,MⅡoocytes rate,the number of high-quality embryos,2PN fertilization rate,cleavage rate,and the number of transferred embryos between three groups(P>0.05).The blastocyst formation rate of group C was significantly lower than group B(56.2%vs.60.7%,P<0.05),and the high-scoring blastocyst rate were significantly lower than group A and B(19.7%vs.24.8%,24.5%,P<0.05).The proportion of D3 transplanted embryos in group A and B were significantly higher than group C(64.5%,61.1%vs.46.3%,P<0.05).The clinical pregnancy rate and embryo implantation rate gradually decreased with the increase of E_(2)/fol(66.4%vs.61.5%vs.56.7%,49.7%vs.45.5%vs.42.2%)among the three groups,but there was no statistical difference(P>0.05).The positive HCG rate of group A was significantly higher than group C(80.9%vs.70.1%,P<0.05).There was no significant difference in abortion rate and multiple pregnancy rate among the three groups(P>0.05).Conclusions:In the fresh embryo transfer cycle with GnRH agonist long protocol in early follicular phase,the serum E_(2) level per mature follicle does not significantly affect the number of obtained oocytes,embryo quality and clinical pregnancy rate.However,the appropriate low level of E_(2)/fol may associated higher high-quality blastocyst formation rate and positive HCG rate.