陈银枚，谢青贞，杨一凡，夏旖，周小丹

(武汉大学人民医院生殖中心/湖北省辅助生殖与胚胎发育医学临床研究中心，武汉 430060)

HCG扳机前E2水平及变化对黄体期长方案IVF助孕结局的影响

陈银枚，谢青贞，杨一凡，夏旖，周小丹

(武汉大学人民医院生殖中心/湖北省辅助生殖与胚胎发育医学临床研究中心，武汉 430060)

目的研究黄体期长方案IVF/ICSI-ET助孕周期中，HCG扳机前雌二醇(E2)水平及变化对助孕结局的影响。

方法回顾性分析2011年1月至2014年8月在我院生殖中心采用黄体期长方案助孕的IVF/ICSI-ET周期1 913个，根据扳机日E2水平变化分组：A组(1 664个周期)，E2上升；B组(249个周期)，E2下降。为研究E2水平对妊娠结局的影响，又将A组分为两个亚组：A1组(1 038个周期，E2≥14 640 pmol/L)和A2组(626个周期，E2<14 640 pmol/L)。比较各组患者的一般资料、促排卵情况、胚胎发育情况及临床妊娠结局。结果A、B两组的获卵数、移植数、冷冻数和受精率、卵裂率、优胚率无显著性差异(P>0.05)；A1组的获卵数和冷冻数显著高于A2组，移植数显著低于A2组(P<0.05)。A、B两组鲜胚移植的种植率、临床妊娠率、活产率、多胎率、异位妊娠率、早期流产率和OHSS发生率均无显著性差异(P>0.05)；A1、A2组的活产率、多胎率、异位妊娠率和早期流产率亦无显著性差异(P>0.05)，A1组的种植率和临床妊娠率显著低于A2组，OHSS发生率显著高于A2组(P均<0.05)。结论HCG扳机前E2升降对妊娠结局无明显不良影响，但扳机前过高的E2可能会损害子宫内膜容受性继而影响胚胎着床，对妊娠结局造成不利影响。过高的E2可能增加OHSS的发生率，因此建议对HCG扳机前E2上升的高E2患者，可考虑行全胚冷冻。

雌二醇； HCG； 体外受精-胚胎移植； 妊娠结局

Objective： To assess the impact of change and serum E2level prior to HCG trigger on pregnancy outcome of IVF/ICSI with prolonged GnRH agonist protocol in luteal phase.

Methods： The data of pregnancy outcome of 1913 IVF/ICSI-ET cycles with prolonged GnRH agonist protocol in Center for Reproductive Medicine，Renmin Hospital of Wuhan University between January 2011 and August 2014 were retrospectively analyzed.The cycles were divided into two groups：group A(E2levels increase on HCG trigger day，n=1 664)，group B(E2levels reduction on HCG trigger day，n=249).In order to study the effect of E2level on pregnancy outcome，group A were further subdivided into two groups：group A1(E2≥14 640 pmol/L，n=1 038)and group A2(E2<14 640 pmol/L，n=626).The general information，ovulation induction，embryonic development and clinical pregnancy outcome were compared among the groups.

Results： There were no significant differences in number of oocytes retrieved，number of embryos frozen，fertilization rate，cleavage rate，good-quality embryo rate，and implantation rate between group A and group B(P>0.05).The number of oocytes retrieved and the number of embryo frozen in A1 group were significantly higher than those in group A2(P<0.05).There were no significant differences in implantation rate of fresh embryos，clinical pregnancy rate，live birth rate，multiple birth rate，ectopic pregnancy rate，early abortion rate and OHSS incidence between group A1 and A2(P>0.05).There were no significant differences in the live birth rate，multiple birth rate，ectopic pregnancy rate and early abortion rate between group A1 and A2(P>0.05).However，the implantation rate and clinical pregnancy rate in group A1 were significant lower than those in group A2，and the OHSS incidence in group A1 was significant higher than that in group A2(P<0.05).

Conclusions： The reduction of E2levels before HCG trigger did not show a significant adverse effect on the pregnancy outcome，but the excessive serum E2level prior to HCG trigger may increase OHSS incidence.Therefore，it is recommended to consider whole embryo frozen for the patients with excessive serum E2level prior to HCG trigger.

Keywords： Estradiol； HCG； IVF-ET； Pregnancy outcome

(JReprodMed2017，26(10)：1000-1005)

目前世界范围内不孕不育夫妇在已婚育龄夫妇中的比例已上升至10%～15%[1]，越来越多的育龄夫妇需要辅助生殖技术的治疗。控制性卵巢刺激(COS)是IVF/ICSI-ET的关键步骤之一，目前我国最常用的COS方案是黄体期长方案。有研究表明，COS所致的体内超生理范围的高雌二醇(E2)可能损害子宫内膜容受性从而影响胚胎着床，且COS过程中过高的E2并发卵巢过度刺激综合征(OHSS)的风险增大[2-3]。因此，本研究旨在探讨扳机前E2的水平及变化对IVF/ICSI-ET妊娠结局的影响。

资料与方法

一、研究对象及分组