Hu Xiaokun, Luo Yingyi, Huang Kejun, Li Yubing, Xu Yanwen, Zhou Canquan, Mai Qingyun
From the Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China.
Medicine (Baltimore). 2016 May;95(20):e3691. doi: 10.1097/MD.0000000000003691.
The aim of this study was to investigate 2 quantification criteria to evaluate the developmental condition of follicles cohort and clarify their impacts upon the determining of human chorionic gonadotropin trigger timing and the reproductive outcome: the proportion of mature follicles in growing follicles cohort on the day of human chorionic gonadotropin trigger and the peak estradiol level per oocyte on the day of human chorionic gonadotropin administration.Of the patients who underwent in vitro fertilization/ intracytoplasmic sperm injection-embryo transfer from 2011 to 2013, 492 controlled ovarian hyperstimulation cycles using gonadotropin-releasing hormone antagonists reaching the ovum pick-up and fresh embryo-transfer stage were included. Patients were divided into 3 groups according to their ≥17 mm/≥10 mm follicles ratio on the day of human chorionic gonadotropin administration (Low proportion: ≤30%, Middle proportion: 30%-60%, High proportion: ≥60%). Patients were divided into 5 groups according to their peak estradiol level/oocyte (Group A: <100 pg/mL per oocyte, Group B: 100-199 pg/mL per oocyte, Group C: 200-299 pg/mL per oocyte, Group D: 300-399 pg/mL per oocyte, Group E ≥400 pg/mL per oocyte) as well. Comparison among groups was made regarding ovarian stimulation characteristics, fertilization rate, good quality embryo rate, implantation, pregnancy, and live birth rates.On the basis of ≥17 mm/≥10 mm follicles ratio, the number of oocyte retrieved in low proportion group is more than other 2 groups. Implantation rate, clinical pregnancy, and live birth rate in high proportion group were 25.8%, 42.7%, and 31.1%, respectively, which is highest in 3 groups, and statistical significance existed between high and middle proportion groups. When the division is based on peak estradiol level/oocyte, the number of oocyte retrieved of ≥400 pg/mL per oocyte Group was significantly lowest compared with the other 4 groups. Matured ovum rate, fertilization rate, and good quality embryos rate exhibited an increasing trend as the peak estradiol level/oocyte increased. While pregnancy rate, implantation rate, and live birth rate were found to be lower whenever estradiol/oocyte ratio exceeded 400 pg/mL per oocyte or less than 100 pg/mL per oocyte, and there is statistical difference.Patients with the proportion of mature follicle reaching 60% on the day of human chorionic gonadotropin trigger and peak estradiol/oocyte level within 100∼399 pg/mL range can get a better pregnancy and implantation rate.
本研究旨在探讨2种量化标准，以评估卵泡群的发育状况，并阐明它们对人绒毛膜促性腺激素扳机时机的确定及生殖结局的影响：人绒毛膜促性腺激素扳机日生长卵泡群中成熟卵泡的比例，以及人绒毛膜促性腺激素给药日每个卵母细胞的雌二醇峰值水平。纳入2011年至2013年接受体外受精/卵胞浆内单精子注射-胚胎移植的患者，共492个使用促性腺激素释放激素拮抗剂且达到取卵和新鲜胚胎移植阶段的控制性卵巢刺激周期。根据人绒毛膜促性腺激素给药日≥17 mm/≥10 mm卵泡比例将患者分为3组（低比例组：≤30%，中比例组：30%-60%，高比例组：≥60%）。还根据每个卵母细胞的雌二醇峰值水平将患者分为5组（A组：每个卵母细胞<100 pg/mL，B组：每个卵母细胞100-199 pg/mL，C组：每个卵母细胞200-299 pg/mL，D组：每个卵母细胞300-399 pg/mL，E组：每个卵母细胞≥400 pg/mL）。比较各组的卵巢刺激特征、受精率、优质胚胎率、着床率、妊娠率和活产率。基于≥17 mm/≥10 mm卵泡比例，低比例组获取的卵母细胞数量多于其他2组。高比例组的着床率、临床妊娠率和活产率分别为25.8%、42.7%和31.1%，是3组中最高的，高比例组与中比例组之间存在统计学差异。当根据每个卵母细胞的雌二醇峰值水平进行分组时，每个卵母细胞≥400 pg/mL组获取的卵母细胞数量明显低于其他4组。随着每个卵母细胞的雌二醇峰值水平升高，成熟卵子率、受精率和优质胚胎率呈上升趋势。而当雌二醇/卵母细胞比例超过每个卵母细胞400 pg/mL或低于每个卵母细胞100 pg/mL时，妊娠率、着床率和活产率较低，且存在统计学差异。人绒毛膜促性腺激素扳机日成熟卵泡比例达到60%且每个卵母细胞的雌二醇峰值水平在100∼399 pg/mL范围内的患者可获得较好的妊娠和着床率。
