HCG注射日孕酮水平和体外受精-胚胎移植妊娠结局的关系探讨  

Impact of progesterone level on the day of human chorionic gonadotrophin administration on outcome of in vitro fertilization

作　　者：王丽娟 胡晓东 莫美兰 彭月婷 曾勇 

机构地区：[1]深圳中山泌尿外科医院,广东深圳518045

出　　处：《中国优生与遗传杂志》2013年第7期116-118,140,共4页Chinese Journal of Birth Health & Heredity

基　　金：广东省医学科学技术研究基金(编号:B2012331);深港创新圈(编号:ZYB200907090141A)

摘　　要：目的探讨在控制性超排卵中,HCG注射日孕酮水平与体外受精-胚胎移植(IVF-ET)妊娠结局的关系。方法回顾性分析2009年10月至2011年3月在我院生殖中心采用长方案垂体降调节行IVF-ET的889个新鲜周期,以及2009年10月至2011年11月因HCG日P≥4.76nmol/L而取消新鲜胚胎移植,后行第1周期冷冻胚胎移植的56个冷冻周期临床资料。按照HCG注射日血清孕酮水平的不同分为3组,A组:P<3.17nmol/L者657周期;B组:3.17nmol/L≤P<4.76nmol/L者181周期;C组:P≥4.76nmol/L者51周期。结果 C组种植率和临床妊娠率明显降低,HCG日平均卵泡径线及异位妊娠率升高,与其余各组比较差异有统计学意义(P<0.05),而各组间成熟卵率、受精率、卵裂率、优质胚胎率差异无统计学意义。C组取消移植的患者冻融胚胎移植周期临床妊娠率较移植组明显增加。结论控制性超排卵中,HCG注射日孕酮水平升高不影响胚胎的质量,但影响新鲜周期的妊娠结局,不影响解冻周期的妊娠率,建议其放弃新鲜胚胎移植,全部胚胎冷冻。Objective： To evaluate the impact of progesterone level on the day of human chorionic gonadotrophin administration on pregnancy outcome of in vitro fertilization in controlled ovarian hyperstmiulation.Methods： Retrospective analysis the 889 cycles of IVF-ET which were used with down regulation long protocol in our reproductive medical centre from October 2009 to March 2011,and 56 cycles of FET which had given up fresh embryo transfer because of high progesterone levels from October 2009 to November 2011.All the patients were divided into three groups according to serum progesterone level on the day of HCG admin istration,group A： P 3.17nmol / L 657 cycles;group B： 3.17nmol / L≤P 4.76nmol / L 181 cycles;group C： P≥4.76nmol / L 77 cycles.Results： Compared with the other two groups,P≥1.5ng / ml group significantly reduced implantation and pregnancy rates but the average follical diameter and the actopic pregnancy rate was significantly higher（P 0.01）.There were no statistical differences in the number of fetilization rates,embryos cleavage rates,high quality embryos rates.Compared with C group,the patients giving up fresh embryo transfer because of high progesterone levels have higher clinical pregnancy rates of frozen thawed embryo transfer cycles.Conclusions： In controlled ovarian hyperstmiulation,the increase of progesterone level on the day of human chorionic gonadotrophin admin istration has effect only on clinical pregnancy outcome of IVF-ET,w ithout affecting on clinical pregnancy rate of thawed embryo transfer.Therefore,the patients who have high progesterone levels maybe considered giving up fresh embryo transfer and freezing total embryo.

关 键 词：孕酮水平 体外受精-胚胎移植 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]