PCOS患者行体外受精-胚胎移植HCG扳机日雌二醇水平对围产期结局的影响

Effect of estradiol level with HCG trigger day on perinatal outcome in PCOS patients undergoing IVF-ET

目的 探讨多囊卵巢综合征(PCOS)患者新鲜胚胎移植中超生理水平的雌二醇(E_(2))对围产期结局的影响。方法 回顾性分析2013年2月至2021年3月期间在广东医科大学附属医院生殖中心行新鲜周期IVF-ET治疗患者的临床资料,共316个周期。根据病因分为PCOS组(n=104)和对照组(n=212),再以HCG扳机日血清E_(2)水平3 000 pg/ml(11 010 pmol/L)为界进一步分为PCOS组E_(2)<3 000 pg/ml者(A组,n=72)、PCOS组E_(2)≥3 000 pg/ml者(B组,n=32)、对照组E_(2)<3 000 pg/ml者(C组,n=148)、对照组E_(2)≥3 000 pg/ml者(D组,n=64)。比较各组患者的一般资料、实验室指标及妊娠结局,对比分析组间围产期结局情况及其相关因素。结果 各组间新鲜胚胎移植周期中移植胚胎类型、临床妊娠率、总流产率、早期流产率比较均无统计学差异(P>0.05);B组中重度卵巢过度刺激综合征(OHSS)发生率及晚期流产率显著高于A、C组,D组中重度OHSS发生率显著高于C组(P<0.05)。各组间临床分娩周期的分娩孕周、分娩方式、新生儿性别、新生儿体重等比较均无统计学差异(P>0.05);各组间围产期母婴并发症发生情况比较亦无统计学差异(P>0.05)。结论 PCOS患者中,HCG日E_(2)水平对新鲜IVF-ET周期的母婴围产期结局没有显著影响,但HCG日高水平E_(2)可能增加PCOS患者新鲜胚胎移植周期的晚期流产率;HCG日E_(2)水平的升高可能增高OHSS的发生率。

Objective:To explore the influence of the super physiological estradiol level on perinatal outcome of fresh embryo transfer cycles in patients with polycystic ovary syndrome(PCOS).Methods:The data of patients(316 cycles)who underwent fresh-cycle IVF-ET in the Reproductive Center of Affiliated Hospital of Guangdong Medical University from February 2013 to March 2021 were retrospectively analyzed.According to the etiology,they were divided into PCOS group and control group.Then the patients were further divided into PCOS E_(2)<3000 pg/ml group(group A,n=72),PCOS E_(2)≥3000 pg/ml group(group B,n=32),control E_(2)<3000 pg/ml group(group C,n=148),and control E_(2)≥3000 pg/ml group(group D,n=64)according to cut-off value of serum estradiol(E_(2))level of 3000 pg/ml(11010 pmol/L)on HCG trigger day.The general data,laboratory indexes and pregnancy outcomes of the patients were analyzed,and the perinatal outcomes and related factors among the groups were compared and analyzed.Results:There were no significant differences in the type of embryo transferred,clinical pregnancy rate,total abortion rate and early abortion rate in the fresh embryo transfer cycle among the groups(P>0.05).The incidence of moderate to severe ovarian hyperstimulation syndrome(OHSS)and late abortion rate in group B were significantly higher than those in group A and C(P<0.05),and the incidence of moderate to severe OHSS in group D was significantly higher than that in group C(P<0.05).There were no significant differences in the delivery weeks,delivery methods,newborn sex,newborn weight and other aspects of the clinical delivery cycle among groups(P>0.05).There was no significant difference in the incidence of perinatal complications among the groups(P>0.05).Conclusions:In PCOS patients,the E_(2) level on HCG day has no significant effect on perinatal outcomes of mothers and infants in fresh IVF-ET cycles,but high E_(2) level on HCG day may increase the late abortion rate of fresh embryo transfer cycles in PCOS patients.The increase of E_(2) level on HCG day may increase the incidence of OHSS.