促排4d后血清雌二醇水平对早卵泡期长效长方案获卵数大于20个的预测价值

Predictive value of serum estradiol level after 4 days of controlled ovarian hyperstimulation for oocytes retrieval more than 20 in early follicular phase prolonged protocol in IVF-ET

目的探讨在体外受精-胚胎移植(IVF-ET)中卵巢高反应患者使用早卵泡期长效长方案促排卵早期血清雌激素水平对获卵数>20个的预测价值。方法回顾病例对照研究分析408例卵巢高反应患者的IVF-ET取卵周期,均采用早卵泡期长效长方案,按获卵数是否>20个分为A、B两组,比较两组促排4 d后血清雌二醇(E_(2))、超促排周期促性腺激素(Gn)启动剂量、Gn用量、Gn天数、正常受精率、D3高评分胚胎率、中重度OHSS发生率,并通过受试者工作特征(ROC)曲线分析促排4 d后E_(2)水平对获卵数大于20个的预测价值。结果两组相比,A组(获卵数>20个)促排4 d后E水平、中重度OHSS发生率均高于B组(获卵数≤20个),而D3高评分胚胎率低于B组,差异均有统计学意义(均P<0.05)。促排4 d后E_(2)水平预测获卵大于20个的ROC曲线下面积为0.761,最佳截断值为547.50 pmol/L,灵敏度为67.30%,特异度为67.10%。结论在控制性促排卵中,针对采用早卵泡期长效长方案的卵巢高反应女性,促排4 d后血清E_(2)水平可作为预测获卵数>20的有效指标。

Objective To explorethe the serun estradiol level during early phase in patients with high ovarian response using early follicular phase prolonged protocol in IVF-ET.Methods A retrospective case-controlanalysis of the clinical data of 408 cycles with an early follicular phase prolonged protocol in patients of high ovarian response.They were divided into two groups according to the number of oocytes retrieved,the two groups were compared with serum estradiol after 4 days of stimulation,Gn dosage,Gn using days,normal fertilization rate,D3 high score embryo rate and moderate or severe OHSS incidence.Estradiol(E_(2)),Gn dosage,Gn days,normal fertilization rate,D3 high score embryo rate,moderate to severe OHSS incidence,Thus using the receiver operating characteristic(ROC)curve to analysis of estradiol level after 4 days of ovulationinduction for predicting the number of number of oocytes retrieved.Results The estradiol level,and the incidence of moderate or severe OHSS after 4 days of ovulation induction in group A(number of retrieved oocytes>20)were higher than those of group B(number of retrieved oocytes≤20),while the rate of embryos with high scores in D3 Lower than group B,the differences were statistically significant(all P<0.05).The area under the ROC curve for predicting the number of oocytes retrieved by estradiol levels after 4 days of ovulation stimulation was 0.761,the best cut-off value was 547.50 pmol/L,the sensitivity was 67.30%,and the specificity was 67.10%.Conclusion In controlled ovulation induction for women with high ovarian response using early follicular phase prolonged protocol are adopted,the serum estradiol level after 4 days of ovulation induction can be applied as an effective indicator for predicting the number of oocytes obtained more than 20.