Objective:To analyze the effect of the proportion of follicles with diameter more than 20 mm on HCG day on the pregnancy outcome of IVF/ICSI cycle,and explore more suitable timing for HCG trigger.Methods:In the retrospective study,1 182 cycles in our center from Jan 2013 toOct 2016 were divided into three groups according to the proportion of large follicles(＞20 mm)in the mature follicles(≥14 mm):low proportion≤10％,middle proportion with 10％-30％,high proportion＞30％.The clinical data,laboratory indicators and pregnancy outcome were compared among the three groups.Results:There were no significant differences in female age,infertility type.infertility duration,BMI and basal sex hormone levels(P＞0.05).The number ofantralfollicle(11.10±4.1 1)inthe high proportion group was significantly less than that in the low(12.91±5.06)and middle(12.91±4.90)proportion groups (P＜0.05).The gonadotropin(Gn)dose used in the high proportion group[(2 445.89±850.87)U]was significantly more than that in the in the low[(2 201.32±740.72)U]and middle[(2 227.74±699.90)U] proportion group(P＜0.05).The gonadotropin usage time in the high proportion group was significantly longer than low proportion group [(11.33 ± 2.25) vs.(10.83± 1.75)days,P＜0.05].No statistical difference was found in the levels of FSH,LH and progesterone,as well as endometrial thickness on HCG day(P＞0.05).The E2 level per mature follicle was significantly higher in the high proportion group than that in the low and middle proportion groups [(1 669.48±631.53)vs.(1 451.71±501.2) pmol/L vs.(1 407.48±±582.14)pmol/L,P＜0.001].The number of mature follicles,the number of oocytes retrieved and the rate of high quality embryos in the low and middle proportion groups were significantly increased than the high proportion group(P＜0.05).In terms of pregnancy outcomes,the biochemical pregnancy rate in the high proportion group(49.04％)was significantly lower than that in the middle proportion group (61.93％),but was not different with the low proportion group(58.68％)(P＜0.05).The clinical pregnancy rate in the high proportion group(43.31％)was significantly lower than the other two groups (58.98/％00,54.96 ％)(P＜0.05).There were no significant differences in oocyte maturity,fertilization rate,number of embryos transferred,implantation cycle rate,implantation cancel rate,abortion rate among the three groups(P＞0.05).Conclusions:The high proportion of large follicles may impair the developmental competence of oocytes and decrease the chance of pregnancy.Clinically,the HCG triggering time should be selected when the proportion of large follicles is present in a certain range.%目的 分析HCG扳机日大卵泡(直径＞20 mm)的比例对IVF/ICSI助孕结局的影响,以寻找更加合适的HCG扳机时间. 方法 回顾性分析2013年1月至2016年10月于本院生殖中心进行IVF/ICSI助孕且符合纳入标准的1182个周期,根据HCG日大卵泡(直径＞20 mm)在成熟卵泡(直径≥14 mm)中占有的百分比分为三组,低比例组≤10％;中比例组10％～30％;高比例组＞30％,比较三组患者的临床资料、实验室指标以及妊娠结局. 结果各组患者的年龄、不育类型、不育年限、体重指数、基础性激素水平均无显著性差异(P＞0.05);基础窦卵泡数在高比例组[(11.10±4.11)个]显著低于中比例组[(12.91±4.90)个]和低比例组[(12.91±5.06)个](P＜0.05);高比例组的Gn使用剂量[(2 445.89±850.87)U]明显高于中比例组[(2 227.74±699.90)U]、低比例组[(2 201.32±740.72) U](P＜0.05),且使用时间[(11.33±2.25)vs.(10.83±1.75)d]较低比例组延长,差异有统计学意义(P＜0.05).HCG日三组患者的激素水平[FSH、LH及孕酮(P)]、内膜厚度均无显著性差异(P＞0.05),但HCG日每成熟卵泡雌激素水平高比例组[(1 669.48±631.53) pmol/L]显著高于中比例组[(1 451.71±501.2) pmol/L]和低比例组[(1 407.48±582.14)pmol/L] (P＜0.001);与高比例组相比,中、低比例组的成熟卵泡数、获卵数及优质胚胎率显著增多,差异有统计学意义(P＜0.05);在妊娠结局:高比例组的生化妊娠率(49.04％)显著低于中比例组(61.93％)(P＜0.05),与低比例组(58.68％0)无显著性差别;高比例组的临床妊娠率(43.31％)明显低于其余两组(58.98％,54.96％)(P＜0.05).各组患者的卵母细胞成熟率、受精率、移植胚胎数、移植周期率、取消移植率以及流产率差异均无统计学意义(P＞0.05). 结论 大卵泡比例过高会降低卵母细胞的发育潜能,影响妊娠结局,临床上进行HCG扳机时应将大卵泡比例控制在一定范围内.
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