摘要
目的探讨移植后7d雌激素水平下降及其幅度对体外受精-胚胎移植（TVF-ET）妊娠结局的影响，观察外源性补充雌激素后能否改善其结局。方法采用回顾性分析研究，选择2009年1-11月及2010年1-11月共772个IVF-ET或卵胞浆单精子注射（ICSI）助孕周期，所有病例均采用标准长方案。其中2009年399个周期移植后7d不补充戊酸雌二醇作为对照组，2010年373个周期作为实验组，移植7d后常规检测E2，与注射绒毛膜促性腺激素（HCG）当天的E2比值；将对照组399个周期与实验组373个周期均按E2下降的幅度分为A组（51％-200％）、B组（31％-50％）、C组（10％-30％）和D组（〈10％），然后实验组A、B组补充戊酸雌二醇3mg／d，C、D组补充戊酸雌二醇6mg／d，对照组则不补充，比较各组间临床妊娠率、流产率、获卵数和胚胎移植日内膜厚度。结果（1）实验组与对照组各组间及其各亚组间临床妊娠率比较差异无统计学意义（P〉0．05）；（2）C、D两组即E2大幅下降实验组较对照组流产率明显下降，差异有显著统计学意义（P〈0．02）；对照组内分析，D组，即E2下降幅度最大组流产率显著增加（P〈0．05）；（3）实验组与对照组各组间及各亚组间获卵率、子宫内膜厚度差异无统计学意义（P〉0．05）。结论（1）E2下降及其幅度与获卵数、ET日的内膜厚度不相关，不影响临床妊娠率，外源补充戊酸雌二醇对改善临床妊娠率意义不大；（2）E2水平大幅度下降，流产率增加，补充外源性E2对此有改善；（3）服用戊酸雌二醇组未见畸形率增加，其在孕早期是安全的。
Objective To explore the effect of the decline and amplitude of estrogen levels on pregnancy outcome 7 days after in vitro fertilization and embryo transfer （IVF/ET）, and to investigate whether exogenous supple- mentation of estrogen could improve the outcome. Methods A total of 772 IVF or ICSI cycles from January to No- vember in 2009 （399 cycles, the control group） and from January to November in 2010 （373 cycles, the study group） were retrospectively analyzed. All cases adopt standard long Protocol. The control group received no pentanoic acid es- tradiol 7 days after IVF/ET, while the study group received pentanoic acid estradiol. The ratio of the E2 value 7 days after IVF/ET to that on the day of HCG injected was calculated. According to the ratio, the control group and the study group were further divided into subgroup A （50%-100%）, subgroup B （30%-50%）, subgroup C （10%-30%）, sub- group D （〈10%）, respectively. Subgroup A, B of the study group added pentanoic acid estradiol 3 rag/d, subgroup C, D added pentanoic acid estradiol 6 mg/d. The four subgroups of the control group received no pentanoic acid estradiol. The clinical pregnancy rate, abortion rate, the egg number, and endometrial thickness on the day of IVF/ET were com- pared. Results （1） The clinical pregnancy rate showed no statistically significant difference between the study group and the control group, as well as between the corresponding subgroups （P〉0.05）. （2） The abortion rate in subgroup D of the control group was significantly higher than subgroup A, B, C of the control group （P〈0.05）, while the abortion rate in subgroup C, D of the study group was significantly lower than the control group （P〈0.01）. （3） The egg recovery rate, endometrial thickness showed no statistically significant difference between the groups and subgroups （P〉0.05）. Conclusion （1） The decline and amplitude of estrogen levels on ET day has nothing to do with egg recovery rate, en- dometrial thickness, and does not affect clinical pregnancy rate. （2） E2 levels on ET day dropped substantially, the abortion rate increases, the added exogenous E2 could improve the outcome. （3） Supplementation ofpentanoic acid es- tradiol did not increase deformity rate, which has good safety in early stages of pregnancy.
出处
《海南医学》
CAS
2013年第10期1443-1445,共3页
Hainan Medical Journal
