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首页> 中文期刊> 《南方医科大学学报》 >长方案垂体降调节行IVF-ET时雌二醇水平变化的意义

长方案垂体降调节行IVF-ET时雌二醇水平变化的意义

         
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Objective To investigate the value of serum estradiol increment and serum estradiol/follicles on the day of hCG administration in predicting the clinical outcomes of in vitro fertilization-embryo transfer (IVF-ET). Methods A retrospective analysis of the IVF-ET data was conducted involving 121 patients who received a long gonadotrophin-releasing hormone agonist (GnRHa) protocol. According to the increment of serum estradiol on the day of hCG administration (relative to the level on the day before hCG administration), the patients were divided into 3 groups (Al, A2 and A3) with a increment ratio below 30%, between 30% and 50%, and over 50%, respectively. In addition, according to the ratio of serum estradiol level on hCG day to mature follicle (diameter>14 mm) number, these patients were divided into three groups (Bl, B2 and B3) with the ratio below 250 pg/ml, between 250 and 350 gp/ ml, and over 350 pg/ml, respectively. The hormonal characteristics and clinical outcomes of the IVF-ET cycles were analyzed comparatively. Results Both the clinical pregnancy rate (71.05%) and embryo implantation rate (52.63%) were significantly higher in group A3 than in groups Al and A2 (PO.05). The best clinical pregnancy rate (67.86%) and embryo implantation rate (49.14%) were significantly higher in group B2 than in groups Bl and B3 (P<0.05). Conclusion The variation of serum estradiol shows an important impact on the clinical outcomes of IVF-ET in patients receiving long GnRH-a protocol. Favorable outcomes can be expected with a hCG day serum estradiol increment ratio above 50% and Ez/follicle ratio between 250 and 350 pg/ml.%目的 探讨体外受精-胚胎移植(IVF-ET)中hCG日血清雌二醇(E2)增幅及hCG日单个成熟卵泡对应的E2水平对临床结局的预测价值.方法 选择2009年11月至2010年5月在本中心采用长方案垂体降调节IVF-ET治疗不孕症的患者121例进行回顾性分析,测定IVF治疗周期中E2水平,E2增幅的计算方法为hCG注射日与hCG日前一天血清E2的差值除以hCG日前一天血清E2值.根据增幅不同分成3组:A1组比值≤30%,A2组介于30%至50%之间,A3组≥50%;另依据hCG日血清E2浓度/成熟卵泡(即阴道B超测量卵泡直径≥14mm)个数的比值分为3组:B1组平均单个成熟卵泡对应的E2水平≤50 pg/ml,B2组比值＞250并＜350 pg/ml,B3组比值≥350 pg/ml,分析并比较各组患者临床资料及妊娠结局之间的关系.结果 A3组的临床妊娠率(71.05%)和胚胎着床率(52.63%)均高于A1、A2两组(P＜0.05);B2组的临床妊娠率(67.86%)和胚胎着床率(49.14%)显著高于B1、B3两组(P＜0.05).结论 长方案垂体降调节IVF-ET患者中E2水平的变化对妊娠结局有明显影响,E2水平在hCG注射当日较hCG日前一天增长幅度≥50%以上、hCG日单个成熟卵泡对应的E2水平介于250～350 pg/ml之间临床结局良好.

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