血清雌二醇增幅对体外受精/卵浆内单精子注射-胚胎移植周期妊娠结局的预测价值

摘要

Objective To investigate the predictive value of serum estradiol (E2) amplification in pregnancy outcome of in-vitro fertilization/intracytoplasmic sperm injection-embryo transfer (ICSI-ET) cycles. Methods The clinical data of 362 patients receiving midluteal-phase long protocol were retrospectively analyzed. The level of serum E2 on the next day of human chorionic go-nadotropin (HCG) injection/the level of serum E2 on the day of HCG injection was used to calculate E2 amplification. Receiver operating characteristic curve (ROC curve) was applied to evaluate E2 amplification and the predictive value of progesterone (P) value on the day of HCG injection on the pregnancy outcome of ICSI-ET cycles. Pearson was applied to analyze whether E2 amplification was related to P value on the day of HCG injection. Results The initial dose of follicle stimulating hormone (FSH) in the pregnancy group was obviously less than that in the non-pregnancy group, and normal fertilization rate, high-quality embryonic rate and frozen embryonic number were all higher than those in the non-pregnancy group. The results of ROC curve demonstrated that the application of E2 amplification and P value on the day of HCG injection in clinical pregnancy showed statistical significance , and 9 5 % confidence interval of E2 amplification and P value on the day of HCG injection in area under the curve was (0.507, 0.625) and (0.508, 0.626), respectively. P value on the day of HCG injection was negatively associated with E2 amplification. Conclusion E2 amplification on the next day of HCG injection and P value on the day of HCG injection can effectively assess the determinant time of HCG injection for IVF/ICSI-ET patients receiving midluteal-phase long protocol on pituitary downregulation, and can predict clinical pregnancy.%目的 探讨血清雌二醇(E2)增幅对体外受精/卵浆内单精子注射-胚胎移植(IVF/ICSI-ET)周期妊娠结局的预测价值.方法 回顾性分析362例接受黄体中期长方案患者IVF/ICSI-ET周期的临床资料.以人绒毛膜促性腺激素(HCG)日次日血清E2水平/HCG日E2水平计算E2增幅,采用接受者操作特性曲线(ROC曲线)评价E2增幅和HCG日黄体酮(P)值对IVF/ICSI-ET周期临床妊娠的预测价值,并应用Pearson分析E2增幅与HCG日P值是否相关.结果 妊娠组尿促卵泡素(FSH)启动量明显少于未妊娠组,且正常受精率、优质胚胎率和冷冻胚胎数均明显高于未妊娠组.ROC曲线结果显示E2增幅和HCG日P值用于预测临床妊娠有统计学意义,曲线下面积的95％可信区间分别为(0.507,0.625)和(0.508,0.626).HCG注射日P值与E2增幅呈负相关.结论 HCG日次日E2增幅和HCG日P值可有效衡量黄体中期长方案垂体降调节IVF/ICSI-ET患者HCG日的决定时机,能有效预测临床妊娠.