黄体中期血清雌二醇下降对IVF/ICSI妊娠结局的影响

Effect of serum estradiol decline in mid-luteal phase on pregnancy outcome of IVF-ET

目的探讨黄体中期血清雌二醇(E_(2))下降对体外受精/单精子卵胞浆内注射-胚胎移植(IVF/ICSI-ET)妊娠结局的影响。方法回顾性分析2020年10月至2021年10月在武汉大学人民医院生殖医学中心行IVF/ICSI-ET助孕的不孕患者共212例的临床资料。根据促排卵方案不同分为拮抗剂方案组(n=99例)和卵泡期长方案组(n=113例),再将每个方案中的患者根据妊娠结局分为妊娠组和未妊娠组,比较两种方案不同妊娠结局患者的基本情况,比较两个促排卵方案以及不同妊娠结局患者间的扳机日血清E_(2)水平、D3胚胎移植后第3天(黄体中期)血清E_(2)水平差异以及E_(2)水平下降幅度的差异,并用多因素Logistic回归分析E_(2)水平下降幅度对妊娠结局的影响。结果基本临床资料分析显示,除拮抗剂方案中妊娠组患者扳机日孕酮(P)水平显著低于未妊娠组(P<0.05)外,其余各指标在两种促排卵方案不同妊娠结局患者间均无显著性差异(P>0.05)。在E_(2)水平比较上,拮抗剂方案组扳机日E_(2)显著高于卵泡期长方案组(P<0.05),两组胚胎移植后第3天E_(2)值差异无统计学意义(P>0.05),而E_(2)下降幅度显著高于卵泡期长方案组(P<0.05)。在E_(2)水平与妊娠结局关系分析中表明,对于使用拮抗剂方案的患者,未妊娠组E_(2)下降幅度显著高于妊娠组(P<0.05);且多因素Logistic回归分析结果显示,与E_(2)下降幅度小于35.42%相比,E_(2)下降幅度在35.43%~82.37%范围不影响妊娠结局,而E_(2)下降幅度超过82.38%时临床妊娠率显著下降(P=0.020);对于卵泡期长方案患者,妊娠组与未妊娠组间的E_(2)下降幅度无统计学差异(P>0.05)。结论不同促排卵方案患者的黄体中期血清E_(2)下降幅度有所不同,其中拮抗剂方案患者的E_(2)下降幅度与妊娠结局相关,且当下降幅度大于82.38%时临床妊娠率显著降低;卵泡期长方案患者的黄体中期E_(2)虽有轻微下降,但不影响妊娠结局。

Objective:To explore the effect of estradiol(E_(2))decline in mid-luteal phase on clinical pregnancy outcome of IVF/ICSI-ET cycles.Methods:The clinical data of 212 infertile patients who underwent IVF/ICSI-ET cycles in Center of Reproductive Medicine,Renmin Hospital of Wuhan University from Oct.2020 to Oct.2021 were retrospectively analyzed.The patients were divided into antagonist protocol group(n=99)and the long protocol of follicular phase group(n=113)according to the protocol of ovarian stimulation.The patients in each group were subdivided into pregnancy group and non-pregnancy group based on pregnancy outcome.The basic conditions of patients were compared between the two protocols.The differences of serum E_(2) levels on the trigger day,the serum E_(2) levels and degree of decline on the third day(mid-luteal phase)after Day 3 embryo transfer were compared between the two protocols.And multifactorial logistic regression was used to analyze the effect of the degree of serum E_(2) decline on pregnancy outcome.Results:The analysis results of basic clinical data showed that there were no significant differences in all indicators of the patients with different pregnancy outcomes between the two induced ovulation protocols(P>0.05),except that progesterone(P)levels on the trigger day in the pregnant group of the antagonist protocol were significantly lower than those in the non-pregnant group(P<0.05).In the E_(2) level comparison,the E_(2) level on trigger day in the antagonist protocol group were significant higher than in the long protocol of follicular phase group(P<0.05),and there was no significant difference in the E_(2) level on the third day after embryo transfer between the two groups(P>0.05),while the degree of serum E_(2) decline was significant higher than in the long protocol of follicular phase group(P<0.05).The analysis of the relationship between E_(2) levels and pregnancy outcome showed that the degree of midluteal E_(2) decline in the non-pregnant group was significantly higher than the pregnant group in the antagonist protocol group(P<0.05).Multifactor logistic regression analysis showed that the E_(2) decline between 35.43%-82.37%group did not affect the outcome compared with the E_(2) decline<35.42%group,while the clinical pregnancy rate was significantly decreased in the E_(2) decline>82.38%group(P=0.02).In the long protocol of follicular phase protocol group,there was no significant difference in the degree of E_(2) decline between the pregnant and non-pregnant group(P>0.05).Conclusions:The degree of midluteal E_(2) decline varies among the patients with different induced ovulation protocols.In the antagonist protocol group,the clinical pregnancy rate was significantly associated with the degree of midluteal E_(2) decline.The clinical pregnancy rate decreased significantly when the decrease was more than 82.38%.In the long protocol of follicular phase protocol,although E_(2) level in the midluteal phase decreases slightly,it does not affect the pregnancy outcome.