摘要
目的探讨不同卵巢储备功能的不孕症患者在接受拮抗剂方案超促排卵周期中血清扳机日孕酮(P)/获卵数比值(POI)对体外受精-胚胎移植(IVF-ET)鲜胚移植妊娠结局的预测价值。方法回顾性分析537例接受拮抗剂方案超促排卵且行鲜胚移植患者的临床资料,比较卵巢储备功能减退患者(DOR组,169例)和卵巢储备功能正常患者(正常组,368例)的促性腺激素(Gn)用量、Gn应用时间、血清扳机日雌二醇(E 2)值、血清扳机日P值、获卵数、受精卵数、优质胚胎数以及临床妊娠率(CPR)。两组患者均根据血清扳机日P值(P<1.59 nmol/L、1.59 nmol/L-1<P≤3.18 nmol/L、P>3.18 nmol/L)再细分为3个亚组,DOR组分为A1、B1、C1组,正常组分为A2、B2、C2,比较不同组别获卵数及CPR。采用受试者工作特征(ROC)曲线筛选扳机日POI对CPR预测的cut-off值,并以该值将所有研究对象分为POI≤预测的cut-off值组(D组)和POI>预测的cut-off值组(E组),比较两组间不同扳机日POI组间血清扳机日P水平、获卵数和CPR。结果DOR组Gn用量及Gn应用时间均多于或长于正常组(t=2.74、10.12,P<0.05),而血清扳机日E 2值、血清扳机日P值、获卵数、受精卵数、优质胚胎数、CPR均低于或少于正常组(t=-9.89^-1.14,χ^2=8.53,P<0.05)。A1、B1和C1组获卵数比较差异有显著性(F=9.45,t′=2.26~4.26,P<0.05),A1组CPR高于B1组和C1组(χ^2=7.00,P<0.05);A2、B2和C2组获卵数比较差异具有显著性(F=8.04,t′=2.33~4.01,P<0.05),C2组CPR低于A2组和B2组(χ^2=10.57,P<0.05)。利用扳机日POI值预测CPR的ROC曲线下面积(AUC)为0.60(95%CI=0.552~0.647,P<0.05),cut-off值为0.38(灵敏度为52.0%,特异度为66.2%)。D组的血清扳机日P值低于E组(t=-14.36,P<0.05),而获卵数和CPR均高于E组(t=11.65,χ^2=17.42,P<0.05)。结论不同卵巢储备功能患者具有不同的血清扳机日P值适宜范围。扳机日POI≤0.38者CPR明显增高,该比值对鲜胚移植妊娠结局具有预测价值,对临床治�
Objective To investigate the value of trigger-day serum progesterone(P) to oocyte index(POI) in predicting the outcome of in vitro fertilization-embryo transfer(IVF-ET) cycle in patients with infertility and different ovarian reserve functions receiving antagonist during controlled ovarian hyperstimulation. Methods A retrospective analysis was performed for the clinical data of 537 patients who received antagonist during controlled ovarian hyperstimulation and underwent fresh embryo transfer. The patients with diminished ovarian reserve(DOR group with 169 patients) and the patients with normal ovarian reserve(normal group with 368 patients) were compared in terms of the amount of gonadotropin(Gn) used, duration of Gn treatment, serum estradiol(E2) on trigger day, serum P level on trigger day, number of retrieved oocytes, number of fertilized eggs, number of high-quality embryos, and clinical pregnancy rate(CPR). According to serum P level on trigger day(P<1.59 nmol/L,1.59 nmol/L<P ≤3.18 nmol/L, and P>3.18 nmol/L), the DOR group was further divided into A1, B1, and C1 groups, and the normal group was further divided into A2, B2, and C2 groups;the number of retrieved oocytes and CPR were compared between groups. The receiver operating characteristic(ROC) curve was used to screen out the cut-off value of POI in predicting CPR, and then the patients were divided into group D with POI ≤cut-off value and group E with POI>cut-off value;serum P level on trigger day, number of retrieved oocytes, and CPR were compared between groups. Results Compared with the normal group, the DOR group had a significantly higher amount of Gn used and a significantly longer duration of Gn treatment(t=2.74,10.12,P<0.05), as well as significantly lower serum E2 on trigger day, serum P level on trigger day, number of retrieved oocytes, number of fertilized eggs, number of high-quality embryos, and CPR(t=-9.89--1.14,χ^2=8.53,P<0.05). There was a significant difference in the number of retrieved oocytes between the A1, B1, and C1 groups(F=
作者
曹阳
解洪立
刘梦瑶
刘建新
CAO Yang;XIE Hongli;LIU Mengyao;LIU Jianxin(Department of Reproductive Medicine,The Affiliated Hospital of Qingdao University,Qingdao 266071,China)
出处
《精准医学杂志》
2020年第1期33-37,共5页
Journal of Precision Medicine
基金
山东省自然科学基金资助项目(ZR2019BC028)
青岛市民生科技计划(16-6-2-21-nsh)。
关键词
孕酮水平
孕酮/获卵数比值
鲜胚移植
卵巢储备
妊娠结局
Progesterone
Progesterone to oocyte index
Fresh embryo transfer
Ovarian reserve
Pregnancy outcome