体外受精-胚胎移植中暂时性高催乳素血症对妊娠的影响

摘要

目的 探讨在体外受精与胚胎移植(IVF-ET)中,注射人绒毛膜促性腺激素(HCG)日血清催乳素(PRL)浓度对妊娠的影响.方法 回顾性分析2005年10月至2008年3月期间127个体外受精与胚胎移植周期的资料.结果 在控制性卵巢刺激(COS)中,按注射HCG日血清催乳素浓度不同分4组,依次为＜30ng/mL(A组),≥30～＜60ng/mL(B组),≥60～＜90ng/mL(C组),≥90ng/mL(D组).体外受精与胚胎移植的种植率分别为13.68%、24.16%、15.90%、2.86%;临床妊娠率分别为25.00%、47.17%、29.41%、7.69%.各组的种植率及临床妊娠率差异有统计学意义(x2检验,P值分别为0.018和0.019).进一步进行两两比较,HCG日PRL≥90ng/mL(D组)的种植率及妊娠率明显较PRL水平≥30～＜60ng/mL(B组)低,差异有统计学意义(P值分别为0.005和0.009).结论 控制性卵巢刺激后血清催乳素浓度较基础水平明显升高,导致暂时性高催乳素血症.当HCG注射日血清催乳素明显升高(≥90ng/mL)时,体外受精与胚胎移植的种植率及临床妊娠率明显下降.对控制性卵巢刺激过程中催乳素水平异常的患者给予严密的监测和适当的干预,有助于提高临床妊娠率.%Objective To evaluate the impact of serum prolactin concentration on the day of human chorionic gonadotropin(HCG) administration on clinical outcome of in vitro fertilization and embryo transfer ( IVF-ET). Methods 127 cycles of IVF-ET performed in Reproductive Medical Center of the First Affiliated Hospital, Sun Yat-Sen University of Medical Sciences between October 2005 and March 2008 were analyzed retrospectively. Results Patients were divided into four groups according to serum prolactin concentration [ ＜ 30ng/mL( Group A), ≥ 30 ～ ＜ 60ng/mL ( Group B), ≥60 ～ ＜90 ( Group C), ≥90ng/mL( Group D) ] on the day of HCG administration. Implantation rate was 13.68％,24. 16％, 15.90％ ,2. 86％ respectively and pregnancy rate (PR) was 25.00％ ,47. 17％ ,29. 41％ ,7.69％ respectively in 4 groups. Chi-square test showed that the differences between the implantation rate and pregnancy rate of 4 groups were statistically significant(P =0. 0018 and 0. 0019 respectively). Further analysis revealed that implantation rate and pregnancy rate of Group D was significantly lower than Group B ( P = 0. 005 and 0. 009 respectively). Conclusion During controlled ovarian stimulation,serum prolactin concentration was much higher than basal lever and COS could induce transitory hyperprolactinemia. Implantation rate and clinical pregnancy rate significantly decreased when serum prolactin concentration dramatically increased(≥90ng/mL). To improve the clinical pregnancy rate of IVF-ET,tight monitoring and appropriate intervention are needed for patients with abnormal prolactin level during controlled ovarian stimulation.