卵泡输出率与成熟卵子输出率预测卵巢反应性及妊娠结局  

Prediction of ovarian response and pregnancy outcome by follicular output rate and mature oocyte output rate

作　　者：周小花 游慧娴 汪晨曦 陈余英 尹兰兰 梁晓 马天仲 ZHOU Xiao-hua;YOU Hui-xian;WANG Chen-xi;CHEN Yu-ying;YIN lan-lan;LIANG Xiao;MA Tian-zhong(Affiliated Hospital Of Guangdong Medical University,Zhanjiang 524001)

机构地区：[1]广东医科大学附属医院,湛江524001

出　　处：《生殖医学杂志》2020年第11期1453-1460,共8页Journal of Reproductive Medicine

基　　金：广东省自然科学基金(2018A0303130308);广东省医学科研基金项目(B2019007);湛江市科技发展专项资金竞争性分配项目(2019A01023)。

摘　　要：目的探讨在体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)中,卵泡输出率(FORT)及成熟卵子输出率(MIIOORT)对不孕症患者卵巢反应性及妊娠结局的预测价值。方法回顾性分析2013年1月至2018年8月在我院生殖中心行IVF/ICSI-ET治疗的397例患者临床资料。将FORT及MIIOORT值采用传统阈值分为低、中、高3组,比较3组之间的促排移植情况及妊娠结局。再根据患者获卵数分为卵巢低反应(获卵数<4个)、卵巢中反应(4个≤获卵数≤15个)和卵巢高反应(获卵数>15个)3组,比较该3组间的FORT及MIIOORT值差异。Logistic回归分析临床妊娠率的影响因素。结果(1)FORT值各组比较,FORT值越高,窦卵泡数(AFC)越少,成熟卵泡越多(P<0.05);低FORT组的HCG日E2和P水平、获卵数、MII卵母细胞数、优胚数、囊胚数及冷冻胚胎数均显著低于其他两组(P均<0.05);与高FORT组相比,低FORT组的HCG日LH[(1.86±0.96)vs.(1.46±0.74)U/L]显著升高(P<0.05),中FORT组的Gn总量[(1862.29±707.63)vs.(2110.42±686.79)U]及胚胎冷冻率(20.51%vs.9.70%)显著降低(P均<0.05)。(2)MIIOORT值各组比较,低MIIOORT组的AFC显著高于其他两组(P<0.05);获卵数、MII卵母细胞数、囊胚数及胚胎冷冻率均随MIIOORT的升高而增加(P均<0.05);低MIIOORT组的HCG日E2、HCG日P、成熟卵泡数、冷冻胚胎数及临床妊娠率均显著低于其他两组(P<0.05),而高MIIOORT组的HCG日LH水平显著低于其他两组(P<0.05)。(3)卵巢高反应组的Gn总量显著低,而低卵巢反应组的AFC、FORT、MIIOORT均显著低(P<0.05)。Logistic回归分析显示,临床妊娠率与移植胚胎数[OR=13.783,95%CI(4.765,39.866),P=0.000]和单囊胚移植数[OR=12.316,95%CI(2.236,67.855),P=0.004]呈正相关。结论FORT和MIIOORT可以很好的评估卵巢反应性及妊娠结局。高FORT和MIIOORT患者具有更好的卵巢反应性,低MIIOORT组的妊娠结局较差,在卵巢低反应人群中MIIOORT比FORT能更灵敏的预测卵巢反应性。Objective:To explore the predictive value of follicular output rate(FORT)and mature oocyte output rate(MIIOORT)on ovarian response and pregnancy outcome in infertile women with IVF/ICSI.Methods:The data of 397 patients who received IVF/ICSI-ET treatment in our reproductive center from January 2013 to August 2018 were retrospectively analyzed.According to the FORT and MIIOORT value,the patients were divided into three groups:low,middle and high FORT or MIIOORT value groups.Then they were divided into another three groups according to the number of retrieved oocytes:low response group(<4),medium response group(4≤number of oocytes≤15)and high response group(>15).The differences of FORT and MIIOORT values were compared among the 3 groups.The influencing factors of clinical pregnancy rate were analyzed by logistic regression.Results:(1)In the FORT value groups,the higher the value of FORT,the lower the number of antral follicle count(AFC),and the higher the number of mature follicles(P<0.05).The levels of E2 and progesterone on HCG day,the numbers of oocytes retrieved,MII oocytes,good-quality embryos,blastocysts and frozen embryos in the low Fort group were significantly lower than those in the other two groups(all P<0.05).Compared with high FORT group,the LH level on HCG day in the low FORT group was significantly higher[(1.86±0.96)vs.(1.46±0.74)U/L](P<0.05),the total Gn[(1862.29±707.63)vs.(2110.42±686.79)U]and the embryo frozen rate(20.51%vs.9.70%)in the middle FORT group was significantly lower(P<0.05).(2)In the MIIOORT value groups,the AFC of low MIIOORT group was significantly higher than that of other two groups(P<0.05).With the increase of MIIOORT value,the numbers of retrieved oocytes,MII oocytes,blastocysts and the embryo frozen rate were significantly increased(P<0.05).In the low MIIOORT group,the levels of E2 and progesterone on HCG day,number of mature follicles,number of frozen embryos(3.26±2.74)and clinical pregnancy rate were significantly lower than those in the other two groups(P<0.05).The LH

关 键 词：卵泡输出率 成熟卵母细胞输出率 卵巢反应性 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]