上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (7): 980-.doi: 10.3969/j.issn.1674-8115.2011.07.024

• 论著（临床研究） • 上一篇    下一篇

体外受精周期中注射hCG日雌激素水平对妊娠结局的影响

陈 骞, 牛志宏, 张韶珍, 徐步芳, 冯 云   

  1. 上海交通大学 医学院附属瑞金医院生殖医学中心, 上海 200025
  • 出版日期:2011-07-28 发布日期:2011-07-27
  • 通讯作者: 冯 云, 电子信箱: artruijin@yahoo.com。
  • 作者简介:陈 骞（1978—）, 女, 主治医师, 硕士；电子信箱: c1qpassion@yahoo.com.cn。

Influence of serum estradiol mass concentrations on day of hCG administration during in vitro fertilization on pregnancy outcomes

CHEN Qian, NIU Zhi-hong, ZHANG Shao-zhen, XU Bu-fang, FENG Yun   

  1. Center of Reproductive Medicine, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China
  • Online:2011-07-28 Published:2011-07-27

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摘要：

目的 探讨体外受精周期中注射人绒毛膜促性腺激素（hCG）日雌激素高水平对新鲜周期和随后的冻融周期妊娠结局的影响。方法 收集采用长方案进行体外受精（IVF）/卵胞浆内单精子显微注射（ICSI）的患者移植周期资料，根据注射hCG日血清雌二醇（E2）的质量浓度分为两组：A组（E2质量浓度≥5 000 pg/mL，n=154）和B组（E2质量浓度<5 000 pg/mL, n=294）；其中A组患者根据首次移植时间又分为两个亚组：A1组（鲜胚移植组，n=78）和A2组（冻胚移植组，n=76）。比较各组周期特征和妊娠结局。结果 A、B两组受精率、卵裂率比较，差异无统计学意义（P>0.05）；两组临床妊娠率和胚胎种植率的差异无统计学意义（P>0.05）；A组的中重度卵巢过度刺激综合征（OHSS）的发生率（4.55%）显著高于B组（1.36%）（P<0.05）。A2组首次胚胎冻融移植周期的临床妊娠率（48.68%）和胚胎种植率（29.14%）显著高于A1组和B组（P<0.05）。结论 E2水平升高是卵巢高反应的表现，与IVF结局没有明显关系，但患者发生OHSS的风险随之升高；对E2高水平的患者采用全胚胎冻存的方法能够获得满意的妊娠结局。

关键词: 雌二醇, 体外受精, 全胚胎冻存, 妊娠

Abstract:

Objective To evaluate the influence of high estradiol (E2) mass concentrations on the day of human chorionic gonadotrophin (hCG) administration during in vitro fertilization (IVF) on pregnancy outcomes of fresh IVF cycles and subsequent frozen-thawed embryo transfer cycles. Methods The data of patients undergoing IVF/intracytoplasmic sperm injection (ICSI) with long protocol were collected, and patients were divided into two groups according to serum mass concentrations of E2 on the day of hCG administration. The serum mass concentration of E2 on the day of hCG administration was ≥5 000 pg/mL in group A (n=154), and that was <5 000 pg/mL in group B (n=294). Patients in group A were subdivided into group A1 (fresh embryo transfer group, n=78) and group A2 (frozen embryo transfer group, n=76). The characteristics of transfer cycles and pregnancy outcomes were compared among groups. Results There was no significant difference in the fertilization rates and cleavage rates between group A and group B (P>0.05). There was no significant difference in the pregnancy rates and embryo implantation rates between group A and group B (P>0.05). The incidence of moderate and severe ovarian hyperstimulation syndrome (OHSS) in group A was significantly higher than that in group B (4.55% vs 1.36%)(P<0.05). The pregnancy rate (48.68%) and embryo implantation rate (29.14%) in group A2 were significantly higher than those in group A1 and group B （P<0.05）. Conclusion High serum E2 mass concentrations on the day of hCG administration are related to ovarian hyperresponsiveness and increased risk of OHSS, while have no significant relationship with IVF outcomes. Patients with high serum E2 mass concentrations on the day of hCG administration treated with all-embryo cryopreservation may result in favorable pregnancy outcomes.

Key words: estradiol, in vitro fertilization, all-embryo cryopreservation, pregnancy