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目的:探讨体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)周期中hCG注射次日血清雌二醇(E2)水平较hCG注射日的增幅对超促排卵临床结局的预测价值。方法:回顾性分析362例行黄体中期长方案IVF/ICSI-ET患者的临床资料。hCG注射次日E2增幅=(hCG注射次日血清E2水平-hCG注射日E2水平)/hCG注射日E2水平×100%。根据增幅的不同分成4组:A组增幅>20%,B组增幅为0.1%~20%间,C组为-20%~0%间,D组增幅<-20%。分析4组患者基本临床资料、超促排卵情况以及临床结局各项指标。结果:各组患者的取卵年龄、不孕年限、基础FSH(bFSH)值、降调节剂量、rFSH天数、hCG用量、hCG注射日LH值、2原核(2PN)胚胎数、优质胚胎数、冷冻胚胎数各组间差异均无统计学意义。各组患者的Gn启动剂量、Gn总用量、hCG注射日P值差异均有统计学意义(P<0.05),且各值随着E2增幅的降低逐渐升高。A组的临床妊娠率(56.30%)显著高于B、C、D组(40.27%、42.85%和20.00%),差异有统计学意义(P<0.05)。A组的胚胎种植率(33.86%)虽高于B、C、D组(26.23%、28.65%和16.67%),但差异无统计学意义(P>0.05)。结论:监测黄体中期长方案垂体降调节IVF/ICSI-ET患者hCG注射次日E2增幅水平对临床结局有预测意义,E2水平在hCG注射次日较hCG注射日增幅高达20%以上时,临床结局较好。
OBJECTIVE: To investigate the predictive value of the increase of serum estradiol (E2) level on the day of hCG injection in IVF / ICSI-ET cycles compared with that of hCG injection on the prognosis of hyperstimulation value. Methods: The clinical data of 362 patients with long-term luteal phase IVF / ICSI-ET were retrospectively analyzed. E2 increase of hCG injection the next day = (E2 level on the next day of hCG injection - E2 level on the day of hCG injection) / E2 level on the day of hCG injection × 100%. Divided into four groups according to the increase: A group increased by> 20%, B group increased by 0.1% ~ 20%, C group was -20% ~ 0%, D group increased by <-20%. Analysis of 4 groups of patients basic clinical data, the situation of super-ovulation and clinical outcome of various indicators. Results: The age of fetus, length of infertility, basal FSH (bFSH), down-regulation dose, days of rFSH, hCG dosage, LH value on hCG injection day, number of 2 prokaryotic (2PN) embryos, The number of embryos was not significantly different among groups. Each group of patients Gn start dose, total Gn dose, hCG injection day P values were statistically significant (P <0.05), and the value of E2 increased with the increase of decreased. The clinical pregnancy rate in group A (56.30%) was significantly higher than that in groups B, C and D (40.27%, 42.85% and 20.00%, respectively). The difference was statistically significant (P <0.05). The implantation rate of embryos in group A (33.86%) was higher than that in groups B, C and D (26.23%, 28.65% and 16.67%), but the difference was not statistically significant (P> 0.05). CONCLUSION: The E2 level of hCG injection on IVF / ICSI-ET patients monitoring long-term puberty regimen has predictive value on clinical outcome. When E2 level increases more than 20% on hCG injection day after hCG injection, the clinical outcome better.