应用百分位数法探讨长方案促排卵早期血清雌二醇界值及其应用价值  

Use value of percentile method to discuss the threshold and application of serum estradiol level during early phase of controlled ovarian hyperstimulation in long protoco

作　　者：姚秋萍 方春霞 YAO Qiu-ping;FANG Chun-xia(Center of Reproductive Medicine,Jiaxing Maternity and Child Health Care Hospital,Women and Children's Hospital of Jiaxing University,Jiaxing,Zhejiang 314000,China)

机构地区：[1]嘉兴市妇幼保健院生殖医学中心、嘉兴学院附属妇儿医院,浙江嘉兴314000

出　　处：《中国妇幼保健》2023年第12期2214-2217,共4页Maternal and Child Health Care of China

基　　金：浙江省嘉兴市科技计划项目(2017BY18026)。

摘　　要：目的应用百分位数法计算长方案促排卵5 d血清雌二醇(estradiol,E_(2))水平的界值,探讨其应用价值。方法回顾性分析2015年1月—2020年12月在嘉兴市妇幼保健院生殖医学中心采用长方案促排卵行体外受精-胚胎移植(IVF-ET)治疗的1954例不孕症患者临床资料。采用频数分布法,以第10百分位数及第90百分位数对应的E_(2)值为界值,分析注射促性腺激素5 d E_(2)值过低及过高者增减促性腺激素剂量是否改善卵巢反应性。结果注射促性腺激素5 d第10百分位数对应的E_(2)值为797.5 pmol/L,中位数为1547.0 pmol/L,第90百分位数为3021.5 pmol/L。132例E_(2)≤797.5 pmol/L的患者在促排卵5~6 d即行促性腺激素加量(加量组),54例患者促性腺激素剂量未变(对照组1)。加量组注射促性腺激素5 d的E_(2)水平显著低于对照组1,促性腺激素加量后获卵数、D3优胚数高于对照组1,卵巢低反应发生率低于对照组1。130例E_(2)>3021.5 pmol/L的患者在促排卵5~6 d即行促性腺激素减量(减量组),45例患者促性腺激素剂量未变(对照组2)。减量组注射促性腺激素5 d的E_(2)水平显著高于对照组2,促性腺激素减量后卵巢高反应发生率显著下降,获卵数、D3优胚数无显著差异。结论长方案促排卵5 d E_(2)≤797.5 pmol/L者需要增加促性腺激素剂量来增加获卵数,减少卵巢低反应发生,促性腺激素5 d E_(2)>3021.5 pmol/L者需要减少促性腺激素剂量以降低卵巢高反应发生率。Objective To calculate the threshold of serum estradiol(E_(2))level by percentile method on day 5 after COH,and to in-vestigate its application value.Methods The data of 1954 infertility patients undergone IVF-ET with the long protocol from January 2015 to December 2020 was analyzed retrospectively.Using the frequency distribution method,the E,value corresponding to the 10th and 90th percentiles was used as the boundary value to analyse whether increasing or decreasing Gn dose improved ovarian reactivity in patients with too low or too high Gn 5days E_(2)value.Results The value of Ez corresponding to the 10th percentile of Gn 5days was 797.5 pmol/L,and the median was 1547 pmol/L,the 90th percentile was 3021.5 pmol/L.132 patients with E_(2)<797.5 pmol/L received Gn increment after 5 days of COH(increment group),and 54 patients had no change in Gn dose(control group 1).The level of E_(2)at Gn 5days in the incre-ment group was significantly lower than that in the control group 1,the number of eggs obtained and the number of D3 excellent embryos were higher than that in the control group 1,and the incidence of ovarian hyporeaction was lower than that in the control group 1.Gn dose was reduced in 130 patients with E_(2)>3021.5 pmol/L after 5 days of COH(reduced group),while Gn dose remained unchanged in 45 pa-tients(control group 2).The level of E_(2)at Gn 5 days in the reduced group was significantly higher than that in the control group 2,the in-cidence of ovarian hyperreaction was significantly decressed after the reduction of Gn,and there were no significant differences in the number of eggs obtained and the number of D3 excellent embryos.Conclusion The patients with E_(2)<797.5 pmol/L after 5days of COH in long pro-tocol requires an increase in Gn dose to increase the number of eggs obtained and reduce the occurrence of ovarian low response.For Gn 5 days E_(2)>3021.5 pmol/L,the Gn dose should be reduce the incidence of high response.

关 键 词：长方案 雌二醇 卵巢反应 

分 类 号：R169.499[医药卫生—公共卫生与预防医学]