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目的探讨不同卵泡数孕酮升高持续时间对体外受精/卵细胞质内单精子注射(IVF/ICSI)妊娠结局的影响。方法回顾性分析在该院生殖医学中心接受IVF/ICSI助孕的患者,共400个周期及后续511个冷冻周期。按人绒毛膜促性腺激素(h CG)日双侧卵巢≥14 mm卵泡数不同分为两组,h CG日≥14 mm卵泡数<10个为A组,h CG日≥14 mm卵泡数≥10个为B组;以h CG日孕酮≥2.0 ng/ml为孕酮升高,按孕酮升高天数分为3组。仅h CG日孕酮升高为1组,至h CG日孕酮升高2 d为2组,至h CG日孕酮升高≥3 d为3组。比较A1、A2、A3 3组患者和B1、B2、B3 3组患者的促排及实验室指标以及后续冻融胚胎移植(FET)周期的妊娠结局。结果 A1组与A2组比较,A1组与A3组比较可移植胚胎数、可移植胚胎率差异均有统计学意义(均P<0.05),A1组与A2组比较优质胚胎数、优质胚胎率差异均有统计学意义(均P<0.05)。A1与A2两组患者后续FET周期的种植率、临床妊娠率差异均有统计学意义(均P<0.05)。而B组患者一般资料、获卵数及实验室相关指标及后续FET周期的种植率、临床妊娠率、早期流产率3组比较差异均无统计学意义(均P>0.05)。结论孕酮升高持续时间对妊娠结局的影响与卵泡数有明显关系。如卵泡数较多,考虑可能为多个卵泡少量分泌孕激素引起的升高,如卵泡直径较小,可继续给予促排,取卵后采取全胚冷冻并择期行冷冻胚胎移植;如卵泡数较少,则不排除黄素化孕酮升高的可能,需尽快决定取卵术,术后采取全胚冷冻并择期行冷冻胚胎移植。
Objective To investigate the effect of different progesterone levels in different follicles on the pregnancy outcome of in vitro fertilization / intracytoplasmic sperm injection (IVF / ICSI). Methods A total of 400 cycles and subsequent 511 cycles of cryogenic cycles were retrospectively analyzed in patients receiving IVF / ICSI in the Reproductive Medicine Center of the hospital. According to the number of ovarian follicles ≥ 14 mm on the day of human chorionic gonadotropin (h CG), the number of follicles was divided into two groups. 10 for the B group; h CG progesterone ≥ 2.0 ng / ml as progesterone increased progesterone increased days divided into 3 groups. Only h CG daily progesterone increased to 1 group, to h CG progesterone increased 2 d to 2 groups, to h CG day progesterone ≥ 3 d for the 3 groups. The patients in groups A1, A2 and A3 were compared with those in B1, B2 and B3 groups, and the pregnancy outcomes of subsequent cycles of freeze-thaw embryo transfer (FET) were compared. Results Compared with A2 group, there were significant differences in the number of transplanted embryos and transferable embryos between A1 group and A3 group (all P <0.05). There was no significant difference in the number of high quality embryos between A1 and A2 All were statistically significant (P <0.05). The implantation rate and clinical pregnancy rate of follow-up FET cycles of A1 and A2 patients were statistically different (all P <0.05). However, there was no significant difference in the general data, number of oocytes retrieved, laboratory-related indexes and follow-up FET cycles implantation rate, clinical pregnancy rate, and early abortion rate among the three groups (all P> 0.05). Conclusion The effect of prolonged progesterone on pregnancy outcome is significantly related to the number of follicles. If the number of follicles is more, consider the possibility of small progesterone secretion caused by a small number of follicles, such as small follicle diameter, can continue to give rise to row, take whole embryo after ovulation and frozen embryo transfer elective; such as the number of follicles Less, then do not rule out the possibility of luteinized progesterone increased, as soon as possible to decide oocyte retrieval, after surgery to take whole embryo freezing and elective frozen embryo transfer.