长效GnRH-a降调促排方案HCG次日孕酮水平对IVF临床结局的影响  

Impact of progesterone level after HCG administration on the outcome of IVF in long GnRH-agonist pituitary suppression protocol

作　　者：沈晓月 山惠枝 蒋玥 孔娜[1] 孙海翔[1] SHEN Xiao-yue;SHAN Hui-zhi;JIANG Yue;KONG Na;SUN Hai-xiang(Reproductive Medicine Center,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008)

机构地区：[1]南京大学附属鼓楼医院生殖医学中心,南京210008

出　　处：《生殖医学杂志》2018年第6期505-509,共5页Journal of Reproductive Medicine

基　　金：国家自然科学基金青年科学基金项目(81601246)

摘　　要：目的探讨IVF周期长效GnRH-a降调促排卵方案中HCG次日孕酮(P)水平对临床妊娠结果及促排卵结果的影响。方法回顾性分析本中心2014~2015年行长效GnRH-a降调促排卵方案并行HCG日P及次日P检测的941个周期的临床资料,以HCG次日P分布的不同百分位截断值,分为3组:Ⅰ组(P≤14.17nmol/L),Ⅱ组(14.17nmol/L<P<46.16nmol/L),Ⅲ组(P≥46.16nmol/L),比较3组的促排卵结局。再进一步将鲜胚移植的634个周期按照上述P截断值分为3组,A组(79个周期),B组(532个周期),C组(23个周期),比较3组的临床结局。结果Ⅰ、Ⅱ、Ⅲ3组患者的Gn用量、HCG日E2、HCG日P、获成熟卵数、可用胚胎数比较均有显著性差异(P<0.001),IVF正常受精率3组间无显著性差异(P>0.05)。A、B、C 3组的Gn用量、Gn天数、HCG日E2、HCG日P、成熟卵数、可用胚胎数与Ⅰ~Ⅲ组的结果相似,C组的Gn用量最少,HCG日E2、P最高,成熟卵数、可用胚胎数最多(P<0.05)。3组间IVF正常受精率、种植率、临床妊娠率、活产率、流产率比较均无显著性差异(P>0.05),但种植率及临床妊娠率C组较A组、B组有下降趋势。结论 HCG次日P水平的高低并不影响IVF临床妊娠率,但是HCG次日高P可能会使种植率及临床妊娠率有下降趋势,因此,HCG次日P明显升高时也需要慎重选择是否行鲜胚移植。Objective：To explore the impact of the serum progesterone level after HCG administration on the outcomes of IVF-ET in long GnRH-agonist pituitary suppression protocol.Methods： The data of 941 cycles of IVF-ET in our center from 2014 to 2015 were retrospectively analyzed.The cycles were divided into 3 groups according to the different percentile cutoffs of serum progesterone（P）on the next day of HCG administration：groupⅠ（P≤14.17 nmol/L）,groupⅡ（14.17 nmol/LP46.16 nmol/L）,group Ⅲ（P≥46.16 nmol/L）.The clinical outcomes were compared among the three groups.Then 634 cycles of fresh embryo transplantation were further subdivided into 3 groups according to the abovementioned progesterone percentile cut-off values：group A（79 cycles）,group B（532 cycles）,group C（23 cycles）.The clinical outcomes were compared among the three groups.Results：There were significant differences in gonadotropin（Gn）dosage used,E2 P levels on HCG day,number of mature oocytes,and number of available embryos among the group I,ⅡandⅢ（P〈0.001）.IVF normal fertilization rate was not significantly different among the 3 groups（P〈0.05）.The Gn doses days used,E2 P levels on HCG day,mature oocytes,and number of available embryos in groups A,B,and C were similar to those in groups I toⅢ.The Gn doses used was the least,and E2 P levels on HCG day,the number of mature oocytes and the number of available embryos were the highest in group C（P〈0.05）.There was no significant difference in IVF fertilization rate,implantation rate,clinical pregnancy rate,live birth rate and miscarriage rate among the 3 groups（P〈0.05）.There was a downward trend in fertilization rate and clinical pregnancy rate in group C,compared with group A B.Conclusions：The serum progesterone level after HCG administration had no impact on clinical pregnancy rate in IVF,but too high progesterone level on the next day after HCG administration would decline the implantation rate and clinical pregnancy rate.Therefore,when

关 键 词：孕酮 HCG日 IVF-ET 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]