获卵困难患者补充肌注hCG的临床效果研究

Clinical effect of hCG supplementation in patients with oocyte retrieval difficulty

目的探讨获卵困难发生的危险因素及有效的方案措施。方法回顾性分析郑州大学第二附属医院生殖中心2016年12月至2021年8月采用卵泡期长效长方案、黄体期长效长方案和短效长方案行体外受精-胚胎移植(in vitro fertilization-embryo transfer, IVF-ET)助孕的620例患者的临床资料。根据常规剂量人绒毛膜促性腺激素(human chorionic gonadotropin, hCG)扳机36 h后获卵难易程度及是否采取补救措施分为3组,A组(n=38):获卵困难,未采取补救措施;B组(n=122):当发现取不到卵时,立即中止手术操作,补充肌注hCG 5 000 IU,2 h后二次取卵;C组(n=460):获卵顺利(对照组)。比较各组的一般资料及IVF促排相关资料及结局。结果 3组患者一般资料比较,差异无统计学意义(P>0.05);A、B两组促性腺激素天数、hCG日雌二醇、孕酮水平、≥15 mm的卵泡数均大于C组(P<0.05);A、B两组hCG日黄体生成素(luteinizing hormone, LH)、hCG次日水平均显著低于C组(P<0.05);A组成功获卵率(89.47%)显著低于B组(99.18%)和C组(100%)(P<0.05);A组平均获卵数、优质胚胎数、冷冻胚胎数、MII卵率、优质胚胎率均显著低于B、C组(P<0.05);A组无可利用胚胎率显著高于B、C组(P<0.05);3组卵巢过度刺激综合征发生率、临床妊娠率、流产率比较,差异均无统计学意义(P>0.05);Logistic回归分析hCG日LH低水平、hCG次日低水平是获卵困难的独立危险因素(P<0.05)。结论 LH/hCG相对不足是造成获卵困难的重要因素,取卵日补充hCG 5 000 IU可提高获卵成功率及获卵数,降低周期取消率。

Objective To explore the risk factors and effective remedial measures of oocytes retrieval difficulty.Methods The clinical data of 620 patients recieved in vitro fertilization-embryo transfer(IVF-ET) treatment in the Reproductive Center of the Second Affiliated Hospital of Zhengzhou University from 2016 to 2021 were analyzed.They were divided into three groups according to whether the oocyte retrieval operation were successful and whether remedial measures were taken.Group A(n=38):difficult to retrieve oocyte with no remedial measures;Group B(n=122):the operation was immediately stopped when it turned out we can’t get oocyte, and oocyte were extracted again after adding human chorionic gonadotropin(hCG) 5 000 IU two hours later.Group C(n=460):oocyte retrieval operation was smooth.The general characteristics and IVF outcomes of each group were analyzed.Results There was no significant difference in general characteristics among the three groups(P>0.05);the usage of Gn, Gn days, the number of follicles≥15 mm, estradiol(E;)and progesterone(P) levels on hCG day in group A and group B were higher than those in group C(P<0.05);the luteinizing hormone(LH) levels on hCG day and the hCG levels after hCG day in group A and B were significantly lower than those in group C(P<0.05);the oocyte retrieval success rate in group A(89.47%) was significantly lower than that in group B(99.18%) and group C(100%)(P<0.05);the average number of retrieved oocytes, high quality embryos, frozen embryos, MII ovum rate and high quality embryo in group A were significantly lower than those in groups B and C(P<0.05);the unavailable embryos rate in group A was significantly higher than that in group B and C(P<0.05);the ovarian hyperstimulation syndrome(OHSS) rate, clinical pregnancy rate and abortion rate were not significantly different among these three groups(P>0.05);Logistic regression analysis showed that low LH levelson hCG day and low hCG levels after hCG day were independent risk factors for oocyte retrieval difficulty(P<0.05).Conclusion The relative shortage of LH/hCG is the important factor causing oocyte retrieval difficulty.Supplementing 5 000 IU of hCG on the oocyte retrieval day can improve the oocyte retrieval success rate and reduce the cycle cancellation rate.