HCG日直径大于20 mm的卵泡比例对IVF/ICSI助孕结局的影响  

Effect of proportion of large follicles on HCG day on the outcome of IVF/ICSI

作　　者：谢燕秋 李松[1] 林海燕[1] 焦雪丹[1] 杨茜 张清学[1] XIE Yan-qiu;LI Song;LIN Hai-yan;JIAO Xue-dan;YANG Xi;ZHANG Qing-xue(Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou　510120)

机构地区：[1]中山大学孙逸仙纪念医院,广州510120

出　　处：《生殖医学杂志》2018年第4期345-349,共5页Journal of Reproductive Medicine

基　　金：中山大学5010常规项目(2016004)

摘　　要：目的分析HCG扳机日大卵泡(直径>20mm)的比例对IVF/ICSI助孕结局的影响,以寻找更加合适的HCG扳机时间。方法回顾性分析2013年1月至2016年10月于本院生殖中心进行IVF/ICSI助孕且符合纳入标准的1 182个周期,根据HCG日大卵泡(直径>20mm)在成熟卵泡(直径≥14mm)中占有的百分比分为三组,低比例组≤10%;中比例组10%~30%;高比例组>30%,比较三组患者的临床资料、实验室指标以及妊娠结局。结果各组患者的年龄、不育类型、不育年限、体重指数、基础性激素水平均无显著性差异(P>0.05);基础窦卵泡数在高比例组[(11.10±4.11)个]显著低于中比例组[(12.91±4.90)个]和低比例组[(12.91±5.06)个](P<0.05);高比例组的Gn使用剂量[(2 445.89±850.87)U]明显高于中比例组[(2 227.74±699.90)U]、低比例组[(2 201.32±740.72)U](P<0.05),且使用时间[(11.33±2.25)vs.(10.83±1.75)d]较低比例组延长,差异有统计学意义(P<0.05)。HCG日三组患者的激素水平[FSH、LH及孕酮(P)]、内膜厚度均无显著性差异(P>0.05),但HCG日每成熟卵泡雌激素水平高比例组[(1 669.48±631.53)pmol/L]显著高于中比例组[(1 451.71±501.2)pmol/L]和低比例组[(1 407.48±582.14)pmol/L](P<0.001);与高比例组相比,中、低比例组的成熟卵泡数、获卵数及优质胚胎率显著增多,差异有统计学意义(P<0.05);在妊娠结局:高比例组的生化妊娠率(49.04%)显著低于中比例组(61.93%)(P<0.05),与低比例组(58.68%)无显著性差别;高比例组的临床妊娠率(43.31%)明显低于其余两组(58.98%,54.96%)(P<0.05)。各组患者的卵母细胞成熟率、受精率、移植胚胎数、移植周期率、取消移植率以及流产率差异均无统计学意义(P>0.05)。结论大卵泡比例过高会降低卵母细胞的发育潜能,影响妊娠结局,临床上进行HCG扳机时应将大卵泡比例控制在一定范围内。Objective:To analyze the effect of the proportion of follicles with diameter more than 20 mm on HCG day on the pregnancy outcome of IVF/ICSI cycle,and explore more suitable timing for HCG trigger.Methods:In the retrospective study,1 182 cycles in our center from Jan 2013 to Oct 2016 were divided into three groups according to the proportion of large follicles(>20 mm)in the mature follicles(≥14 mm):low proportion≤10%,middle proportion with 10%-30%,high proportion>30%.The clinical data,laboratory indicators and pregnancy outcome were compared among the three groups.Results:There were no significant differences in female age,infertility type,infertility duration,BMI and basal sex hormone levels(P>0.05).The number of antral follicle(11.10±4.11)in the high proportion group was significantly less than that in the low(12.91±5.06)and middle(12.91±4.90)proportion groups(P<0.05).The gonadotropin(Gn)dose used in the high proportion group[(2 445.89±850.87)U]was significantly more than that in the in the low[(2 201.32±740.72)U]and middle[(2 227.74±699.90)U]proportion group(P<0.05).The gonadotropin usage time in the high proportion group was significantly longer than low proportion group[(11.33±2.25)vs.(10.83±1.75)days,P<0.05].No statistical difference was found in the levels of FSH,LH and progesterone,as well as endometrial thickness on HCG day(P>0.05).The E 2 level per mature follicle was significantly higher in the high proportion group than that in the low and middle proportion groups[(1 669.48±631.53)vs.(1 451.71±501.2)pmol/L vs.(1 407.48±582.14)pmol/L,P<0.001].The number of mature follicles,the number of oocytes retrieved and the rate of high-quality embryos in the low and middle proportion groups were significantly increased than the high proportion group(P<0.05).In terms of pregnancy outcomes,the biochemical pregnancy rate in the high proportion group(49.04%)was significantly lower than that in the middle proportion group(61.93%),but was not different with the low proportion group(58.68%)(P<0.05).The cli

关 键 词：HCG扳机 卵泡径线 临床妊娠率 IVF/ICSI 

分 类 号：R714.8[医药卫生—妇产科学]