长方案垂体降调节行IVF-ET时雌二醇水平变化的意义  

Value of serum estradiol concentration in predicting the clinical outcome of IVF-ET in patients receiving long protocol of GnRHa

作　　者：倪郝[1] 陈雷宁[1] 全松[1] 李红[1] 华芮[1] 高瑞花[1] 陈思梅[1] 罗琛[1] 

机构地区：[1]南方医科大学南方医院妇产科生殖医学中心,广东广州510515

出　　处：《南方医科大学学报》2011年第2期365-368,共4页Journal of Southern Medical University

基　　金：广东省自然科学基金(9151051501000066)

摘　　要：目的探讨体外受精-胚胎移植(IVF-ET)中hCG日血清雌二醇(E2)增幅及hCG日单个成熟卵泡对应的E2水平对临床结局的预测价值。方法选择2009年11月至2010年5月在本中心采用长方案垂体降调节IVF-ET治疗不孕症的患者121例进行回顾性分析,测定IVF治疗周期中E2水平,E2增幅的计算方法为hCG注射日与hCG日前一天血清E2的差值除以hCG日前一天血清E2值。根据增幅不同分成3组:A1组比值≤30%,A2组介于30%至50%之间,A3组≥50%;另依据hCG日血清E2浓度/成熟卵泡(即阴道B超测量卵泡直径≥14 mm)个数的比值分为3组:B1组平均单个成熟卵泡对应的E2水平≤250 pg/ml,B2组比值>250并<350 pg/ml,B3组比值≥350 pg/ml,分析并比较各组患者临床资料及妊娠结局之间的关系。结果 A3组的临床妊娠率(71.05%)和胚胎着床率(52.63%)均高于A1、A2两组(P<0.05);B2组的临床妊娠率(67.86%)和胚胎着床率(49.14%)显著高于B1、B3两组(P<0.05)。结论长方案垂体降调节IVF-ET患者中E2水平的变化对妊娠结局有明显影响,E2水平在hCG注射当日较hCG日前一天增长幅度≥50%以上、hCG日单个成熟卵泡对应的E2水平介于250～350 pg/ml之间临床结局良好。Objective To investigate the value of serum estradiol increment and serum estradiol/follicles on the day of hCG administration in predicting the clinical outcomes of in vitro fertilization-embryo transfer（IVF-ET）.Methods A retrospective analysis of the IVF-ET data was conducted involving 121 patients who received a long gonadotrophin-releasing hormone agonist（GnRHa） protocol.According to the increment of serum estradiol on the day of hCG administration（relative to the level on the day before hCG administration）,the patients were divided into 3 groups（A1,A2 and A3） with a increment ratio below 30%,between 30% and 50%,and over 50%,respectively.In addition,according to the ratio of serum estradiol level on hCG day to mature follicle（diameter≥14 mm） number,these patients were divided into three groups（B1,B2 and B3） with the ratio below 250 pg/ml,between 250 and 350 gp/ml,and over 350 pg/ml,respectively.The hormonal characteristics and clinical outcomes of the IVF-ET cycles were analyzed comparatively.Results Both the clinical pregnancy rate（71.05%） and embryo implantation rate（52.63%） were significantly higher in group A3 than in groups A1 and A2（P0.05）.The best clinical pregnancy rate（67.86%） and embryo implantation rate（49.14%） were significantly higher in group B2 than in groups B1 and B3（P0.05）.Conclusion The variation of serum estradiol shows an important impact on the clinical outcomes of IVF-ET in patients receiving long GnRH-a protocol.Favorable outcomes can be expected with a hCG day serum estradiol increment ratio above 50% and E2/follicle ratio between 250 and 350 pg/ml.

关 键 词：体外受精-胚胎移植 长方案垂体降调节 HCG注射日 雌二醇 临床结局 

分 类 号：R714.8[医药卫生—妇产科学]