体外受精-胚胎移植患者黄素化起始前后激素水平差异对累积助孕结局影响的研究  

Effect of sex hormone levels before and after the initiation of luteinization in patients with IVF-ET on cumulative outcome of assisted pregnancy

作　　者：张多多 甄璟然[1] 王含必[1] 郁琦[1] 邓成艳[1] ZHANG Duo-duo;ZHEN Jing-ran;WANG Han-bi;YU Qi;DENG Cheng-yan(Department of Gynecological Endocrinology&Reproductive Medicine,Peking Union Medical College Hospital,Peking Medical College/Chinese Academy of Medical Sciences,Beijing 100730)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇科内分泌与生殖中心,北京100730

出　　处：《生殖医学杂志》2020年第12期1551-1556,共6页Journal of Reproductive Medicine

摘　　要：目的探讨促排卵的多卵泡发育状态下促性腺激素及性激素的变化规律,旨在阐明这一非生理性激素改变及其是否与IVF/ICSI助孕结局有关。方法研究纳入了2014年7月1日至2018年3月31日期间于北京协和医院因输卵管因素或男方因素行IVF或ICSI治疗的女性共3009人,根据不同妊娠结局(有累积妊娠vs.无妊娠;有累积活产vs.无活产),用重复测量方差分析的方法,对比了不同促排卵时间点(基础状态T0、扳机日T1及扳机后一天T2)的性激素水平,并且分析了T2相对于T1时间各种性激素的增减趋势与助孕结局的关系。结果对于有累积妊娠或有累积活产者,FSH在任何时间点均显著低于无累积妊娠或无累积活产者(P<0.001);LH则相反,有累积妊娠或累积活产者基础LH水平稍高(P<0.05),之后(T1、T2)均显著低于妊娠结局较差(无累积妊娠或累积活产)组(P<0.001)。雌二醇在T1和T2均在有累积妊娠或累积活产的一组中呈现更高的水平(P<0.001),孕酮仅仅在T2表现出这种浓度优势(P<0.001)。有累积妊娠或累积活产组,雌二醇及孕酮增长水平在T2相对于T1的增量更大(P<0.001)。结论促排卵状态下扳机及早期黄体期性激素水平及其波动与累积妊娠结局密切相关。Objective:To explore the changes of gonadotropins and sex hormones in the multiple follicles developmental status under induced ovulation,in order to clarify this non-physiological hormone changes and whether it is related to IVF/ICSI pregnancy outcome.Methods:A total of 3009 women who underwent IVF or ICSI treatment due to fallopian tube factors or male factors in Peking Union Medical College Hospital from 1 st July 2014 to 31 st March 2018were included in the study.According to different pregnancy outcomes(cumulative pregnancy vs.no pregnancy;cumulative live birth vs.no live birth),the method of repeated measurement analysis of variance was used to compare sex hormone levels at different time points[basic state(T0),trigger day(T1),and the day after trigger day(T2)]of ovulation induction,and the relationship between the increase and decrease trends of various sex hormones at T2 relative to T1 and the outcome of assisted pregnancy was analyzed.Results:For patients with cumulated clinical pregnancy or live birth,FSH levels at any points were significantly lower than those with no cumulative pregnancy or no cumulative live birth(P<0.001),while LH levels were the opposite,the basic LH level was slightly higher in those with cumulative pregnancy or cumulative live birth(P<0.05),and after that,the LH levels at T1&T2 were significantly lower than those with poor pregnancy outcome(P<0.05).Estradiol levels were significantly higher at T1 and T2 in the group with cumulative pregnancy or cumulative live birth(P<0.001),and progesterone levels were only higher at T2(P<0.001).In the cumulative pregnancy or cumulative live birth group,the increase in estradiol and progesterone levels at T2 was greater than that at T1(P<0.001).Conclusions:The variation of sexual hormone levels and their fluctuations in the trigger day and the early luteal phase under ovulation induction are closely related to the outcome of cumulative pregnancy.

关 键 词：体外受精-胚胎移植 累积妊娠率 累积活产率 扳机 性激素 黄体早期 

分 类 号：R711.6[医药卫生—妇产科学]