上海交通大学学报（医学版）

›› 2009, Vol. 29 ›› Issue (7): 850-.

• 论著（临床研究） • 上一篇    下一篇

控制性超促排卵过程中雌激素水平对IVF-ET结局的影响

陆 湘, 李 路, 高晓红, 吴 煜, 徐 冰, 孙晓溪   

  1. 上海交通大学 医学院国际和平妇幼保健院生殖医学中心, 上海 200030
  • 出版日期:2009-07-25 发布日期:2009-09-16
  • 通讯作者: 孙晓溪, 电子信箱：sun_xx@hotmail.com。
  • 作者简介:陆 湘（1975—）, 女, 主治医师, 硕士, 电子信箱: luxiang75@yahoo.com.cn。

Effects of serum estradiol levels during controlled ovarian hyperstimulation on outcomes of IVF-ET

LU Xiang, LI Lu, GAO Xiao-hong, WU Yu, XU Bing, SUN Xiao-xi   

  1. Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200030, China
  • Online:2009-07-25 Published:2009-09-16

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摘要：

目的 研究控制性超促排卵（COH）过程中雌激素水平对于体外受精-胚胎移植（IVF-ET）治疗结局的影响。方法 回顾性分析472例采用黄体期长效GnRH-a降调节方案进行IVF-ET治疗患者的临床资料。计算COH过程中雌二醇（E2）水平的曲线下面积（AUC），以E2水平AUC（AUCE2）的百分位数定义卵巢反应并分组，比较各组一般情况及与IVF-ET治疗结局相关指标。结果  AUCE2第10和第90百分位数分别为3 347.0 pmol/L和14 414.3 pmol/L。472例患者分为卵巢低反应组（AUC E2≤3 347.0 pmol/L，48例）、正常反应组（14 414.3 pmol/L>AUCE2>3 347.0 pmol/L，376例）和高反应组（AUCE2≥14 413.3 pmol/L，48例）。各组年龄、体质量指数、基础促卵泡激素水平、促性腺激素应用天数、移植日子宫内膜厚度和移植胚胎数等一般情况比较，差异均无统计学意义（P>0.05）。与低反应组和正常反应组比较，高反应组获卵数和可冷冻胚胎数明显增多（P<0.01），中、重度卵巢过度刺激综合征的发生率较高（P<0.05）；各组受精率、累计胚胎评分、优质胚胎率、临床妊娠率和种植率比较，差异均无统计学意义（P>0.05）。结论 IVF-ET 治疗COH过程中的持续超生理状态的E2水平，在一定范围内对于卵子和胚胎质量以及妊娠率和种植率无明显不良影响。

关键词: 控制性超促排卵, 雌激素, 妊娠率, 种植率

Abstract:

Objective To analyse the effects of serum estradiol levels during controlled ovarian hyperstimulation (COH) on the outcomes of in vitro fertilization and embryo transfer (IVF-ET). Methods The clinical data of 472 patients undergoing IVF-ET with GnRH analogues recombinant FSH long protocol were retrospectively analysed. The area under the curve (AUC) of estradiol (E2) level was calculated during COH, and patients were categorized into groups according to the percentile of AUC of E2 (AUCE2) during COH. The general characteristics and parameters related to the outcomes of IVF-ET were compared among groups. Results The 10th percentile and 90th percentile of AUCE2 were 3 347.0 pmol/L and 14 414.3 pmol/L, respectively. Four hundred and seventytwo patients were divided into lower reaction group (AUC E2≤3 347.0 pmol/L, n=48), normal reaction group (14 414.3 pmol/L>AUCE2>3 347.0 pmol/L, n=376) and higher reaction group (AUCE2≥14 413.3 pmol/L, n=48). There was no significant difference in age, body mass index, baseline follicle stimulating hormone level, time of treatment with gonadotropin, endometrium thickness on day of transfer and embryos transferred（P>0.05）. Compared with lower reaction group and normal reaction group, the number of oocytes per retrieval and number of embryos frozen were significantly larger（P<0.01）and the mild/severe ovarian hyperstimulation syndrome rate was significantly higher in higher reaction group（P<0.05）. There was no significant difference in fertilization rate, cumulative embryo score, high-grade embryo rate, clinical pregnancy rate and implantation rate among groups (P>0.05). Conclusion Sustained supraphysiological serum E2 levels during the COH process do not adversely affect the quality of oocytes and embryos, clinical pregnancy rate and implantation rate to some extent in IVF-ET.

Key words: controlled ovarian hyperstimulation, estradiol, pregnancy rate, implantation rate