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目的探讨在控制性超排卵中,HCG注射日孕酮水平与体外受精-胚胎移植(IVF-ET)妊娠结局的关系。方法回顾性分析2009年10月至2011年3月在我院生殖中心采用长方案垂体降调节行IVF-ET的889个新鲜周期,以及2009年10月至2011年11月因HCG日P≥4.76nmol/L而取消新鲜胚胎移植,后行第1周期冷冻胚胎移植的56个冷冻周期临床资料。按照HCG注射日血清孕酮水平的不同分为3组,A组:P<3.17nmol/L者657周期;B组:3.17nmol/L≤P<4.76nmol/L者181周期;C组:P≥4.76nmol/L者51周期。结果 C组种植率和临床妊娠率明显降低,HCG日平均卵泡径线及异位妊娠率升高,与其余各组比较差异有统计学意义(P<0.05),而各组间成熟卵率、受精率、卵裂率、优质胚胎率差异无统计学意义。C组取消移植的患者冻融胚胎移植周期临床妊娠率较移植组明显增加。结论控制性超排卵中,HCG注射日孕酮水平升高不影响胚胎的质量,但影响新鲜周期的妊娠结局,不影响解冻周期的妊娠率,建议其放弃新鲜胚胎移植,全部胚胎冷冻。
Objective To investigate the relationship between the level of progesterone during HCG injection and pregnancy outcome of IVF-ET in controlled superovulation. Methods A retrospective analysis of 889 fresh cycles of IVF-ET with long-term hypophysectomy in the reproductive center of our hospital from October 2009 to March 2011 and retrospective analysis was performed on the HCG-day P≥4.76 from October 2009 to November 2011 nmol / L to cancel the fresh embryo transfer, followed by the first cycle of frozen embryo transfer of 56 frozen period clinical data. According to the level of serum progesterone HCG injection day is divided into three groups, A group: P <3.17nmol / L in 657 cycles; B group: 3.17nmol / L≤P <4.76nmol / L in 181 cycles; C group: P ≥4.76nmol / L for 51 cycles. Results The implantation rate and clinical pregnancy rate in group C were significantly lower than those in other groups (P <0.05), and the average follicle diameter and ectopic pregnancy rate in HCG group were significantly higher than those in other groups (P <0.05) Fertilization rate, cleavage rate, high-quality embryo rate difference was not statistically significant. The clinical pregnancy rate of frozen-thawed embryo transfer group in C group was significantly higher than that in transplantation group. Conclusions In controllable superovulation, the increase of progesterone level on HCG injection does not affect the quality of the embryo, but the pregnancy outcome affecting the fresh cycle does not affect the pregnancy rate of the thaw cycle. It is recommended to abandon the fresh embryo transfer and freeze all the embryos.