Al-Banoon Fertility Center, Zagazig, Egypt.
Reprod Biomed Online. 2011 Dec;23(6):789-98. doi: 10.1016/j.rbmo.2011.08.011. Epub 2011 Sep 10.
This prospective, randomized, controlled trial tested the hypothesis that delaying embryo transfer to the blastocyst stage can increase the probability of clinical pregnancy and live birth in women with high oestradiol concentrations on the day of human chorionic gonadotrophin (HCG) undergoing intracytoplasmic sperm injection using the long protocol. A total of 200 women with oestradiol >3000 pg/ml on the HCG day with four or more good-quality, day-3 embryos were randomized in a 1:1 ratio to undergo day-3 or day-5 embryo transfer. Clinical pregnancy rates (CPR; 41% versus 59%; relative risk 0.70, 95% CI 0.52–0.93) and ongoing pregnancy/live-birth rates (35% versus 52%; relative risk 0.67, 95% CI 0.46–0.93) were lower in women undergoing cleavage-stage than blastocyst-stage embryo transfer. Using receiver operating characteristic curves, among women undergoing cleavage-stage embryo transfer, a detrimental cut-off value for not achieving pregnancy for oestradiol was 4200 pg/ml, with lower CPR and ongoing pregnancy/live-birth rates (P = 0.006 and 0.02, respectively). No detrimental cut-off value for oestradiol was identified among women undergoing blastocyst-stage embryo transfer. Delaying embryo transfer to the blastocyst stage can increase the probability of pregnancy in women with high oestradiol on the HCG day
这项前瞻性、随机、对照试验检验了这样一个假设，即在使用长方案进行人绒毛膜促性腺激素（hCG）注射时，如果女性在 hCG 日的雌二醇浓度>3000pg/ml 且有≥4 枚优质的第 3 天胚胎，那么将胚胎培养至囊胚阶段而非第 3 天进行移植可以提高临床妊娠率和活产率。200 名雌二醇浓度>3000pg/ml 的女性被随机分为两组，1:1 比例接受第 3 天或第 5 天胚胎移植。与第 3 天胚胎移植相比，第 5 天囊胚移植的临床妊娠率（CPR；41%对 59%；相对风险 0.70，95%CI 0.52-0.93）和持续妊娠/活产率（35%对 52%；相对风险 0.67，95%CI 0.46-0.93）更低。在进行卵裂期胚胎移植的女性中，使用受试者工作特征曲线分析发现，雌二醇未达到妊娠的不利截断值为 4200pg/ml，CPR 和持续妊娠/活产率更低（P=0.006 和 0.02）。在进行囊胚期胚胎移植的女性中，未发现雌二醇的不利截断值。将胚胎移植至囊胚阶段可以提高 hCG 日雌二醇水平高的女性的妊娠概率。
