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目的:探讨在控制性超促排卵(COH)过程中添加低剂量人绒毛膜促性腺激素(hCG)的效果。方法:回顾性分析77例在COH过程中不同时间添加低剂量hCG进行促排卵患者的促排卵效果。结果:P水平在诱发排卵日[1.15(0.65,1.90)ng/ml]显著高于添加hCG日[0.30(0.20,0.56)ng/ml](P<0.05)。39个新鲜胚胎移植周期的生化妊娠率为46.2%(18/39),种植率为24.4%(20/82),临床妊娠率为35.9%(14/39);61个冻融胚胎移植周期的生化妊娠率为41.0%(25/61),种植率为18.4%(23/125),临床妊娠率为32.8%(20/61);无1例发生卵巢过度刺激综合征(OHSS);未孕患者中仍有10个周期还余有优质胚胎未移植。根据促排卵日不同时间添加低剂量hCG(50~200 mg/d)分组(A组≤5 d,n=9;B组6~8 d,n=26;C组9 d,n=19;D组≥10 d,n=23),各组的获卵率、受精率、卵裂率、优质胚胎数均无统计学差异。A~D组诱发排卵日P水平分别为1.00(0.5,1.6)ng/ml、1.32(0.7,2.6)ng/ml、1.30(0.6,2.2)ng/ml、1.09(0.7,1.5)ng/ml,均显著高于添加hCG日[分别为0.20(0.1~0.2)ng/ml、0.30(0.2,0.7)ng/ml、0.30(0.2,0.5)ng/ml、0.44(0.2,0.63)ng/ml](P<0.05或P<0.01)。结论:因卵泡生长缓慢、卵泡大小不均匀、卵泡数量过多,在COH过程中添加低剂量hCG对促排卵结局无影响,虽然诱发日的P水平会有所升高,但对新鲜胚胎移植周期的妊娠结局影响不显著,后续冻融胚胎移植的妊娠结局也较理想。
Objective: To investigate the effect of adding low-dose human chorionic gonadotropin (hCG) during controlled ovarian hyperstimulation (COH). Methods: A retrospective analysis of 77 cases of COH at different times during the addition of low-dose hCG ovulation induction ovulation results. Results: P level was significantly higher than [0.30 (0.20,0.56) ng / ml] on the day of ovulation induction [1.15 (0.65,1.90) ng / ml] (P <0.05). The biochemical pregnancy rate of 39 fresh embryo transfer cycles was 46.2% (18/39), the implantation rate was 24.4% (20/82) and the clinical pregnancy rate was 35.9% (14/39). The 61 cycles of freeze-thaw embryo transfer The biochemical pregnancy rate was 41.0% (25/61), the implantation rate was 18.4% (23/125), and the clinical pregnancy rate was 32.8% (20/61). No ovarian hyperstimulation syndrome (OHSS) There are still 10 cycles remaining in the patient with high-quality embryos not transplanted. According to ovulation date, low-dose hCG (50-200 mg / d) was added at different times (group A ≤5d, n = 9; group B 6-8d, n = 26; group C 9d, n = 19; D group ≥ 10 d, n = 23). There was no significant difference in the number of eggs, fertilization rate, cleavage rate and the number of high quality embryos in each group. The ovulation day P levels in groups A to D were 1.00 (0.5,1.6) ng / ml, 1.32 (0.7,2.6) ng / ml, 1.30 (0.6,2.2) ng / ml and 1.09 Were significantly higher than those on hCG supplementation [0.20 (0.1-0.2) ng / ml, 0.30 (0.2,0.7) ng / ml, 0.30 ] (P <0.05 or P <0.01). Conclusion: Due to the slow growth of follicles, the uneven size of follicles and the excessive number of follicles, the addition of low dose of hCG during COH has no effect on ovulation induction. Although the level of P on induction day will be increased, Of the pregnancy outcome is not significant, follow-up freeze-thaw embryo transfer pregnancy outcomes are also more satisfactory.