拮抗剂方案中HCG扳机日直径16~18 mm卵泡比例对PCOS患者IVF-ET结局的影响

Effect of ratio of follicles in diameter of 16-18 mm on IVF-ET outcomes in PCOS patients on HCG trigger day in antagonist protocols

目的探讨拮抗剂方案中人绒毛膜促性腺激素(HCG)扳机日直径16~18 mm卵泡比例对接受拮抗剂方案的多囊卵巢综合征(PCOS)患者体外受精-胚胎移植(IVF-ET)结局的影响。方法回顾性分析2016年1月至2021年12月于南京医科大学附属妇产医院行IVF-ET助孕的PCOS患者的临床资料。根据HCG扳机日双侧卵巢直径16~18 mm卵泡比例以三分位法将患者分为三组,该比例<0.43为A组(262例),0.43~0.56为B组(267例),≥0.56为C组(247例)。比较三组一般临床资料、超促排卵周期情况、胚胎发育情况、体外受精周期后首次冻融胚胎移植(FET)情况以及妊娠、围产期结局。结果B组基础促黄体生成素(LH)、基础LH与基础促卵泡激素(FSH)比值显著高于A组和C组,差异有统计学意义(P<0.05)。A组促性腺激素(Gn)使用总量高于B组和C组,HCG扳机日雌二醇(E_(2))水平低于B组、C组,差异有统计学意义(P<0.05)。B组和C组获卵数、2原核(PN)数、卵裂数、囊胚形成数以及可移植胚胎数高于A组,差异有统计学意义(P<0.05)。C组囊胚形成率高于A组和B组,高评分囊胚率高于B组,差异有统计学意义(P<0.05)。三组移植胚胎数、移植胚胎天数、内膜准备方案及内膜厚度比较差异无统计学意义(P>0.05)。三组胚胎着床率、生化妊娠率、临床妊娠率、流产率、活产率、妊娠期糖尿病发生率及妊娠期高血压发生率等比较差异无统计学意义(P>0.05)。结论在拮抗剂方案中,HCG扳机日直径16~18 mm卵泡比例可反映卵母细胞发育潜能,当该比例≥0.56时可获得较好的获卵数、2PN数、卵裂数、囊胚形成数以及可移植胚胎数,在一定程度上可作为PCOS患者HCG扳机时机的参考指标,但该比例并不影响后续首次FET的妊娠结局。

Objective To explore the effect of ratio of follicles in diameter of 16-18 mm on in vitro fertilization and embryo transfer(IVF-ET)outcomes in polycystic ovary syndrome(PCOS)patients receiving antagonist protocols on human chorionic gonadotropin(HCG)trigger day in antagonist protocols.Methods The clinical data of PCOS patients undergoing IVF-ET assisted pregnancy in Women′s Hospital of Nanjing Medical University from January 2016 to December 2021 were retrospectively analyzed.The patients were divided into three groups(group A,group B and group C)according to the ratio of follicles in diameter of 16-18 mm in bilateral ovaries on the HCG trigger day using a tertile method.Group A had a ratio<0.43(262 cases),and group B had a ratio between 0.43 and 0.56(267 cases),and group C had a ratio≥0.56(247 cases).The general clinical data,ovulation induction cycles,embryo development,first frozen-thawed embryo transfer(FET)outcomes after IVF-ET cycle,and pregnancy and perinatal outcomes were compared among the three groups.Results The values of baseline luteinizing hormone(LH)and baseline LH to baseline follicle-stimulating hormone(FSH)ratio in group B were significantly higher than those in group A and group C(P<0.05),and the differences were statistically significant(P<0.05).The total dose of gonadotropin(Gn)in group A was higher than that in group B and group C,and estradiol(E_(2))level on the HCG trigger day in group A was higher than that in group B and group C,and the differences were statistically significant(P<0.05).The number of retrieved oocytes,2-pronucleus(PN)embryos,cleavage-stage embryos,and blastocysts,as well as the number of transferable embryos in group B and group C were higher than those in group A,and the differences were statistically significant(P<0.05).The rate of blastocyst formation in group C was higher than that in group A and group B,and the rate of blastocyst formation with high scores in group C was higher than that in group B,and the differences were statistically significant(P<0.05).There were no significant differences among the three groups in terms of the number of transferred embryo,the days of transferred embryos,endometrial preparation protocols and endometrial thickness(P>0.05).There were no significant differences among the three groups in embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate,miscarriage rate,live birth rate,gestational diabetes mellitus incidence and gestational hypertension incidence(P>0.05).Conclusion In the antagonist protocols,the ratio of follicles in diameter of 16-18 mm on HCG trigger day can reflect the developmental potential of oocytes.When the ratio is greater than or equal to 0.56,better retrieved oocytes,2PN embryos,cleavage-stage embryos,blastocyst formation and transferable embryos are achieved,serving as a reference indicator for HCG trigger timing in PCOS patients to a certain extent.However,the ratio does not affect the subsequent first FET pregnancy outcome.