长方案促排卵中hCG扳机后12 h激素水平的变化对IVF/ICSI-ET结局的影响  

Effects of hormone changes 12 h after hCG trigger on the outcomes of IVF/ICSI-ET treatment with GnRH-a protocol

作　　者：吴惠华 朱蕊 李明清[2] 孟庆霞[1] 王馥新[1] 丁洁[1] 李红[1] Wu Huihua;Zhu Rui;Li Mingqing;Meng Qingxia;Wang Fuxin;Ding Jie;Li Hong(Center for Human Reproduction and Genetics,the Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Municipal Hospital,Suzhou 215002,China;Laboratory for Reproductive Immunology,Hospital of Obstetrics and Gynecology,Shanghai Medical School,Fudan University,Shanghai 200080,China)

机构地区：[1]南京医科大学附属苏州医院苏州市立医院生殖与遗传中心,苏州215002 [2]复旦大学附属妇产科医院生殖免疫实验室,上海200080

出　　处：《中华生殖与避孕杂志》2024年第6期610-616,共7页Chinese Journal of Reproduction and Contraception

基　　金：苏州市卫生青年骨干人才“全国导师制”培训项目(Qngg2023017);南京医科大学科技发展基金(NMUB20210280)。

摘　　要：目的探讨长方案体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)超促排卵治疗过程中,人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)扳机12 h后hCG、孕酮水平和雌二醇变化对妊娠结局的影响。方法纳入2015年3月至2020年6月期间在南京医科大学附属苏州医院生殖与遗传中心行长方案IVF/ICSI-ET助孕治疗的2506例患者,对其控制性超促排卵的相关资料进行回顾性分析。采用Spearman秩相关分析和路径分析对hCG扳机12 h后hCG水平、孕酮水平和雌二醇变化的相关影响因素及其对妊娠结局的影响进行分析。结果hCG扳机后hCG水平与孕酮水平呈正相关(r=0.094,P<0.001),与雌二醇变化率呈负相关(r=-0.093,P<0.001)。hCG扳机后孕酮水平与雌二醇变化率呈负相关(r=-0.089,P<0.001)。hCG剂量正向影响hCG扳机后hCG水平,路径系数(path coefficients,PC)为0.307(P<0.001)。体质量指数(body mass index,BMI)负向影响hCG扳机后hCG和孕酮水平(PC=-0.434,P<0.001;PC=-0.154,P<0.001),正向影响雌二醇变化率(PC=0.097,P<0.001)。促性腺激素(gonadotopin,Gn)使用时间和使用总量正向影响hCG后孕酮水平(PC=0.102,P<0.001;PC=0.080,P=0.030)。hCG扳机后hCG和孕酮水平正向影响获卵率(PC=0.098,P<0.001;PC=0.080,P<0.001),而雌二醇变化率对获卵率无明显影响(P>0.05)。hCG扳机日孕酮水平负向影响正常受精率(PC=-0.050,P=0.039)。hCG扳机后hCG水平、孕酮水平和雌二醇变化率对优质胚胎率、临床妊娠率和活产率无明显影响(均P>0.05)。结论在长方案促排卵过程中,hCG扳机后12 h的hCG水平、孕酮水平正向影响获卵率,而对正常受精率、优质胚胎率、临床妊娠率和活产率无明显影响。因而在长方案IVF/ICSI-ET治疗中,需要注意hCG扳机后12 h的hCG水平和孕酮水平。Objective To explore the effects of human chorionic gonadotropin(hCG),progesterone as well as the change of estradiol 12 h after hCG trigger on the outcomes of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).Methods A retrospective study was conducted at the Center for Reproduction and Genetics of the Affiliated Suzhou Hospital of Nanjing Medical University.A total of 2506 patients received IVF/ICSI-ET treatment with gonadotropin-releasing hormone agonist(GnRH-a)protocol from March 2015 to June 2020 were selected.With Spearman rank correlation analysis and path analysis,we explore the relationship among the changes of these hormones and the baseline characteristic of patients,as well as the relationship among the changes of these hormones and the outcomes of IVF treatment.Results The increase of hCG was accompanied by the rise of progesterone and the decline of estradiol change rate(r=0.094,P<0.001;r=-0.093,P<0.001).Meanwhile the rise of progesterone was accompanied by the decline of estradiol change rate(r=-0.089,P<0.001).The dosage of hCG trigger was directly positively correlated to hCG level after hCG trigger,path coefficients(PC)was 0.307(P<0.001).Body mass index(BMI)was directly negatively correlated to hCG level and progesterone level after hCG trigger(PC=-0.434,P<0.001;PC=-0.154,P<0.001),whereas positively correlated to estradiol change rate(PC=0.097,P<0.001).Meanwhile the duration and dosage of gonadotropin(Gn)used were positively correlated to progesterone level after hCG trigger(PC=0.102,P<0.001;PC=0.080,P=0.030).hCG level and progesterone level after hCG trigger had positive correlation to oocyte retrieved rate(PC=0.098,P<0.001;PC=0.080,P<0.001).While estradiol change rate was not correlated to oocyte retrieved rate(P>0.05).Progesterone level on hCG trigger day negatively related to normal fertilization rate(PC=-0.050,P=0.039).hCG level,progesterone level and estradiol change rate after hCG trigger had no correlation with high-quality embryo rate,clinical pregn

关 键 词：人绒毛膜促性腺激素 孕酮 雌二醇变化率 获卵率 受精率 

分 类 号：R714.8[医药卫生—妇产科学]