摘要： 目的 探讨在新鲜胚胎移植周期中，取卵（OPU）日和移植日血清雌二醇（E₂）水平及其日上升率与助孕结局的关系。方法 回顾性分析在我院生殖医学科接受体外受精胚胎移植术（IVF-ET）新鲜胚胎移植患者的临床资料，共纳入192个周期。根据助孕结局，分为临床妊娠组（74个周期）和未妊娠组（118个周期），比较2组患者的一般临床资料。根据OPU日和移植日E₂日上升率各分为3层：OPU日E₂日上升率<12%为A1组（60个周期），12%~<24%为B1组（73个周期），≥24%为C1组（59个周期）；移植日E₂日上升率<30%为A2组（58个周期），30%~<50%为B2组（76个周期），≥50%为C2组（58个周期）。采用受试者操作特征（ROC）曲线分析E₂及其日上升率预测临床妊娠的价值，采用logistic回归分析新鲜胚胎移植患者临床妊娠的预测因素。结果 与未妊娠组相比，临床妊娠组注射人绒毛膜促性腺激素日、OPU日、移植前1 d和移植日E₂水平明显升高（均P < 0.05），4个时点E₂水平曲线下面积（AUC）分别为0.661、0.671、0.721和0.706 （均P < 0.05）。OPU日和移植日E₂日上升率AUC分别为0.573和0.437 （均P > 0.05）。将A1组作为参照，B1组临床妊娠率是A1组的6.70倍（P < 0.05），C1组是A1组的1.36倍（P > 0.05）；将A2组作为参照，B2组临床妊娠率是A2组的0.28倍（P > 0.05），C2组是A2组的0.31倍（P < 0.05）。结论 OPU日E₂日上升率为12%~<24%时行新鲜胚胎移植的临床妊娠结局较好，移植日E₂日上升率≥50%时助孕结局可能不良。

体外受精胚胎移植不同时点雌二醇水平及其日上升率与助孕结局的关系

陈颖^1,2, 于月新², 张倩², 张宁²

1. 中国医科大学研究生院, 沈阳 110122;
2. 北部战区总医院生殖医学科, 沈阳 110015

收稿日期:2020-12-07出版日期:2021-10-30发布日期:2021-10-11
通讯作者:于月新E-mail:yuyuexinpingan@163.com
作者简介:陈颖(1992-),女,硕士研究生.
基金资助:2020年度辽宁省重点研发计划项目（1582529198147）


关键词: 雌二醇, 日上升率, 体外受精胚胎移植术, 临床妊娠
Abstract: Objective To explore the relationship between the serum estradiol (E₂) level as well as its daily increase rate on the days of oocyte pick-up (OPU) and embryo transfer and the outcomes of assisted reproduction. Methods Clinical data from patients who had fresh embryo transfer by in vitro fertilization and embryo transfer (IVF-ET) at our department were retrospectively analyzed. There were 192 IVF cycles. The patients were divided into the clinical pregnancy group (74 cycles) and the no-pregnancy group (118 cycles). The patients were then divided into the A1 (<12%, 60 cycles), B1 (12%-<24%, 73 cycles), and C1 subgroups (≥ 24%, 59 cycles), and the A2 (<30%, 58 cycles), B2 (30%-<50%, 76 cycles), and C2 subgroups (≥ 50%, 58 cycles) based on the daily increase rate of E₂ on the days of OPU and embryo transfer, respectively. Receiver operating characteristic (ROC) curves were created to analyze the potential of serum E₂ level and its daily increase rate in predicting assisted reproduction outcomes. Logistic regression analysis was performed to assess the potential factors for predicting assisted reproduction outcomes. Results The serum E₂ levels on the days of HCG, OPU, and embryo transfer and one day before embryo transfer were significantly higher in the clinical pregnancy group than the no-pregnancy group (all P < 0.05). The areas under the curve (AUCs) at these four time points were 0.661, 0.671, 0.721, and 0.706, respectively (P < 0.05). The AUCs of the daily increase rate of E₂ on the OPU and embryo transfer days were 0.573 and 0.437, respectively (P < 0.05). The clinical pregnancy rates of the B1 and C1 subgroups were 6.70 (P < 0.05) and 1.36 times (P > 0.05) those of the A1 subgroup, and those of the B2 and C2 subgroups were 0.28 (P > 0.05) and 0.31 times (P < 0.05) those of the A2 subgroup, respectively. Conclusion A daily increase rate of E₂ on the day of OPU ranging from 12% to <24% is conducive for a positive pregnancy outcome from a fresh embryo transfer, while a minimum increase rate of E₂ of ≥ 50% on the day of embryo transfer may result in undesirable assisted reproduction outcomes.
Key words: estradiol, daily increase rate, in vitro fertilization and embryo transfer, clinical
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