孕酮/卵泡指数对鲜胚移植周期的临床意义  

Correlation of progesterone-to-follicle index with outcome of fresh embryo transfer cycles

作　　者：龚瑜[1] 周黎明[1] 蔡婕[1] 孙亦婷[1] 赵雅云[1] 夏爱丽[1] GONG Yu ZHOU Liming CAI Jie et al(Department of IVF Center, Ningbo Women and Children＇s Hospital, Ningbo 315012, China)

机构地区：[1]宁波市妇女儿童医院生殖中心,315012

出　　处：《浙江医学》2017年第20期1742-1744,1762,共4页Zhejiang Medical Journal

基　　金：宁波市自然基金项目(2015A610199)

摘　　要：目的探讨孕酮/卵泡指数(PFI)对鲜胚移植周期的临床意义,制定个体化移植方案。方法选择行体外受精/卵胞质内单精子注射鲜胚移植的患者2 906例。根据HCG扳机日血清孕酮水平,将患者分为3组,孕酮≥2.0ng/ml 26例(A组),1.5~<2.0ng/ml 190例(B组),<1.5ng/ml 2 690例(C组);并按照妊娠与否进一步分为妊娠亚组和非妊娠亚组,比较3组妊娠亚组和非妊娠亚组PFI的差异。对PFI有统计学差异组再分析妊娠亚组和非妊娠亚组的年龄、助孕次数、不孕年限、促性腺激素(Gn)启动剂量、Gn天数、Gn总量、HCG扳机日内膜厚度、φ14mm以上卵泡个数、促黄体生成素(LH)、雌二醇(E2)、孕酮水平、移植优胚个数的差异。采用logistic回归分析以上变量、PFI与妊娠率的关系,并对有意义变量按照x±1.96s计算95%参考值范围。结果 B组与C组妊娠率比较差异有统计学意义(P<0.01)。B组妊娠亚组和非妊娠亚组PFI比较差异有统计学意义(P<0.05)。B组logistic回归分析显示最终进入模型的变量为PFI(OR=0.033)。在HCG扳机日孕酮1.5~<2.0范围内,PFI每增加0.01,妊娠率下降0.97%。适合胚胎移植的患者PFI的95%参考值范围为0.187~0.222。结论 HCG扳机日孕酮1.5~<2.0范围内,PFI可作为患者进行鲜胚移植的依据,PFI值越低,妊娠率越高,PFI值高的患者建议取消鲜胚移植。Objective To investigate the correlation of progesterone-to-follicle index （FPI） with the outcomes of fresh embryo transfer. Methods Total 2 906 infertile women underwent in vitro fertilization/intracytoplasmic sperm injection （IVF/ICSI） with fresh embryo transfer between January 2012 and December 2016 in Ningbo Women and Children Hospital Reproductive Center. According to serum progesterone（P） level at hCG trigger day, the patients were divided into three groups： group A （n=26） with P≥2.0ng/ml, group B（n=190） with P≥ 1.5ng/ml and 〈2.0ng/ml, group C （n=2690） with P〈1.5ng/ml. The PFI and pregnancy rate, the age, number of assisted reproduction, infertility years, the Gn starting dose, the Gn days, total Gn dose, endometrial thickness, LH,E2 , P levels on hCG trigger day and the number of transplanted embryos were documented in three groups. The statistical analysis was performed with SPSS software. Results The pregnancy rate of group B was lower than that of group C （P〈0.01）. In group B the PFI of pregnancy group was lower than that of non-pregnancy group （P〈0.05）. Logistic regression analysis showed that PFI was final variables entering the model in group B （OR=0.033）. In P level between 1.5ng/ml and 2.0ng/ml on hCG trigger day, PFI increased per 0.01 with a decrease of pregnancy rate of 0.97%, the optimal range of PFI for embryo transfer was in 0.187-0.222. Conclusion In progesterone range between 1.5ng/ml and 2.0ng/ml on hCG trigger day, PFI can be used as an indicator for fresh embryo transplantation, in cycles with a high PFI, cancellation of embryo transfer should be considered.

关 键 词：孕酮/卵泡指数 体外受精-胚胎移植 孕酮 新鲜周期 

分 类 号：R714.8[医药卫生—妇产科学]