降低hCG的剂量不影响控制性超促排卵中卵泡的最终成熟及随后冷冻胚胎移植的妊娠结局  

Reducing the Trigger Dose of Human Chorionic Gonadotrophin Does Not Affect Final Oocyte Maturation and Subsequently Pregnancy Outcome of Frozen-thawed Embryo Transfer

作　　者：汪云[1] 傅永伦[1] 吕祁峰[1] 曹少锋[1] 陈秋菊[1] 薛松果[1] 匡延平[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院辅助生殖科,上海200011

出　　处：《生殖与避孕》2014年第2期126-130,142,共6页Reproduction and Contraception

摘　　要：目的:在卵巢中等反应和高反应患者中,比较2 000 IU、3 000 IU低剂量hCG与5 000 IU hCG在控制性超促排卵(COH)过程中诱导卵泡成熟及随后冷冻胚胎移植(FET)的妊娠结局。方法:回顾性分析2 166例接受IVF/ICSI治疗的患者的临床资料,根据hCG的剂量分为3组:2 000 IU(A组,n=722),3 000 IU(B组,n=722)和5 000 IU(C组,n=722),观察比较成熟卵母细胞的比例、受精率、临床妊娠率、累计妊娠率及卵巢过度刺激综合征(OHSS)的发生率等。结果:3组患者获得成熟卵母细胞比例(89.92%,91.40%,90.20%)和受精率(79.80%,80.07%,80.51%)均无统计学差异(P>0.05)。A组hCG注射日E2水平、获成熟卵数及优质胚胎数均显著高于B组和C组。3组患者每次移植的临床妊娠率(45.95%,43.97%,44.25%)、继续妊娠率(43.17%,40.91%,42.53%)、种植率(30.74%,27.78%,29.86%)及每位患者的累计妊娠率(CPR)(58.31%,53.60%,54.85%)均无统计学差异。3组的OHSS发生率很低(0.00%,0.14%,0.28%)。结论:对于卵巢中等与高反应患者,2 000 IU hCG与5 000 IU hCG在诱导卵泡的成熟中发挥同样的效果,2 000 IU hCG不仅不影响妊娠结局,而且阻止了OHSS的发生。Objective： To compare the efficacy of human chorionic gonadotrophin （hCG） at reduced doses of 2 000 IU and 3 000 IU for moderate or high responders with the dose of 5 000 IU in term of inducing final oocyte maturation for IVF/ICSI and the subsequent pregnancy outcome in frozen-thawed embryo transfer （FET）. Methods： In the retrospective cohort study, 2 166 patients undergoing IVF/ICSI with moderate or high response were recruited and classified into three groups according to the trigger dose of hCG： 2 000 IU （group A, n=722）, 3 000 IU （group B, n=722） and 5 000 IU （group C, n=722）. The main outcome was the proportion of mature oocytes retrieved, fertilization rates, clinical pregnancy rates, cumulative pregnancy rates and incidence of ovarian hyperstimulation syndrome （OHSS）. Results： No evidence of statistically difference was found in the proportion of mature oocytes retrieved （89.92%, 91.40%, 90.20%, respectively） and fertilization rate （79.80%, 80.07%, 80.51%, respectively） among groups A, B and C. Serum E2 level on the day ofhCG injection, the number of mature oocytes retrieved and good-quality embryos in group A were significantly higher than those in group B and group C. Clinical pregnancy rates per transfer cycle （45.95%, 43.97% and 44.25%）, ongoing pregnancy rates （43.17%, 40.91% and 42.53%）, implantation rates （30.74%, 27.78% and 29.86%） and cumulative pregnancy rates per patient （58.31%, 53.60% and 54.85 %） were comparable among groups A, B and C. The incidence of OHSS in groups A, B and C （0.00%, 0.14% and 0.28%） was low, with no significant difference. Conclusion： A reduced hCG dose of 2 000 IU for moderate or high responders leads to similar efficacy compared with a dose of 5 000 IU in inducing oocyte maturation without adversely affecting the pregnancy outcome meanwhile eliminating the risk of OHSS.

关 键 词：HCG 控制性超促排卵(COH) 卵巢过度刺激综合征(OHSS) 冷冻胚胎移植(FET) 累计妊娠率(CPR) 

分 类 号：R714.8[医药卫生—妇产科学]