COH过程中雌二醇下降对拮抗剂方案IVF-ET助孕结局的影响  

Influence of estradiol decline during COH on IVF-ET outcome with GnRH antagonist protocol

作　　者：徐玲 刘尧芳 XU Ling;LIU Yao-fang(Department of Reproductive Medicine,the Affiliated Hospital of Southwest Medical University,Luzhou 646000)

机构地区：[1]西南医科大学附属医院生殖医学科,泸州646000

出　　处：《生殖医学杂志》2023年第11期1637-1642,共6页Journal of Reproductive Medicine

基　　金：四川省科学技术厅项目(2022YFS0082);西南医科大学附属医院博士启动基金(19084)。

摘　　要：目的分析拮抗剂方案控制性促排卵(COH)过程中雌二醇(E_(2))水平下降对体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕结局的影响。方法回顾性分析2019年1月至2022年12月于我院生殖医学科行IVF/ICSI-ET时采用拮抗剂方案促排卵的385个周期的临床资料,根据患者促排卵过程中E_(2)水平的变化情况分为3组:扳机日前E_(2)下降者为A组(n=38)、扳机日E_(2)下降者为B组(n=81),促性腺激素(Gn)使用过程中E_(2)持续上升者为C组(n=266),比较各组患者的一般情况及IVF-ET结局。结果各组患者间年龄、抗苗勒管激素(AMH)、基础窦卵泡计数(AFC)及基础性激素水平等一般资料比较均无显著性差异(P>0.05)。A组和B组扳机日E_(2)水平、孕酮水平、LH水平、E_(2)/≥14 mm卵泡数、获卵数及扳机日E_(2)/获卵数均显著低于C组(P<0.05);A组的Gn使用天数显著多于B组和C组,而Gn启动剂量显著低于B组和C组(P<0.05);A组和B组的MⅡ卵数、2PN受精数、优质胚胎数均略低于C组,但尚无显著性差异(P>0.05);各组患者新鲜胚胎移植后的胚胎种植率、临床妊娠率比较亦无显著性差异(P>0.05)。结论采用拮抗剂方案促排卵过程中,E_(2)的下降可能会影响扳机日的E_(2)、孕酮、LH水平及获卵数,但对胚胎质量和新鲜胚胎移植结局可能无显著影响。Objective:To analyze the effect of estradiol(E_(2))decline during controlled ovarian hyperstimulation(COH)on IVF-ET outcome with GnRH antagonist(GnRH-ant)protocol.Methods:The clinical data of 385patients(385cycles)who underwent GnRH-ant protocol in the Reproductive Medicine Department in our Hospital from January 2019to December 2022were analyzed retrospectively.The patients were divided into three groups based on the changes in E_(2)levels during ovulation induction:E_(2)level decline before the trigger day(Group A,n=38),E_(2)level decline on the trigger day(Group B,n=81),and E_(2)level sustained increase during gonadotropins(Gn)use group(Group C,n=266).The general data and IVF-ET outcomes of patients were compared among the three groups.Results:There were no significant differences in age,anti-Müllerian hormone(AMH)levels,and basal FSH(bFSH)among the three groups.The E_(2)level,LH level,the ratio of E_(2)level to number of≥14mm follicles,and the oocytes retrieved and the ratio of E_(2)level to number of oocytes retrieved on the trigger day in Group A and B were significantly lower than those in Group C(P<0.05).The Gn days in Group A was significantly more than those in Groups B and C,while the initiation dose of Gn was significantly lower than those in Groups B and C(P<0.05).The number of MⅡ,2PN,and good-quality embryo in Group A and B were slightly lower than those in Group C,but the difference was not significant(P>0.05).There were also no significant differences in embryo implantation rate and clinical pregnancy rate after fresh embryo transfer among the three groups(P>0.05).Conclusions:The E_(2) decline during COH with GnRH-ant protocol may affect the levels of E_(2),progesterone,LH on the trigger day,as well as the number of oocytes retrieved,but may not have a significant impact on embryo quality and fresh.9 m23 embryo transfer outcomes.

关 键 词：体外受精-胚胎移植 控制性促排卵 拮抗剂方案 雌二醇 

分 类 号：R711.6[医药卫生—妇产科学]