Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Chin Med J (Engl). 2019 May 20;132(10):1194-1201. doi: 10.1097/CM9.0000000000000251.
Estradiol, as an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization embryo transfer (IVF-ET) cycles. The aim of this retrospective study was to evaluate the association between elevated serum estradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and IVF-ET pregnancy and birth outcomes.
A total of 1771 infertile patients with their first fresh IVF-ET cycles were analyzed retrospectively between January 2011 and January 2016 in Peking University First Hospital. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 205), group 2 (serum E2 levels 1001-2000 pg/mL, n = 457), group 3 (serum E2 levels 2001-3000 pg/mL, n = 425), group 4 (serum E2 levels 3001-4000 pg/mL, n = 310), group 5 (serum E2 levels 4001-5000 pg/mL, n = 237), and group 6 (serum E2 levels > 5000 pg/mL, n = 137). The retrieved oocyte and MII oocyte numbers and implantation and clinical pregnancy rates of the groups were compared as the first objective of the study. For the 360 women with singleton births among all patients, the area under the corresponding receiver operating characteristic curve (ROC curve) was calculated to assess the predictive value of the E2 change for the probability of low birth weight (LBW) infants as the second objective.
The retrieved oocyte and MII oocyte numbers and implantation and clinical pregnancy rates gradually increased from groups 1 to 5 but decreased in group 6. The parameters of group 1 were statistically worse than those of the other groups, from group 2 to group 6 (the number of retrieved oocytes, t = 13.096, t = 23.307, t = 23.086, t = 26.376, t = 19.636, P < 0.003; the number of retrieved MII oocytes, t = 10.856, t = 20.868, t = 21.874, t = 23.374, t = 19.092, P < 0.003; the implantation rate, χ = 12.179, χ = 22.239, χ = 23.993, χ = 23.344, χ = 16.758, P < 0.003; the clinical pregnancy rate, χ = 16.415, χ = 28.074, χ = 35.387, χ = 37.025, χ = 24.590, P < 0.003). ROC analysis revealed that when a serum peak E2 of 3148 pg/mL was used to predict LBW.
The results indicate that serum E2 levels have a concentration-dependent effect on clinical outcomes. The optimal range of the E2 level during a fresh IVF-ET cycle is 1000 to 3148 pg/mL.
雌二醇作为卵泡发育和子宫内膜容受性的重要激素，与新鲜体外受精胚胎移植（IVF-ET）周期的临床结局密切相关。本回顾性研究旨在评估人绒毛膜促性腺激素（hCG）给药日血清雌二醇（E2）水平升高与 IVF-ET 妊娠和分娩结局的关系。
本研究回顾性分析了 2011 年 1 月至 2016 年 1 月期间北京大学第一医院 1771 例首次接受新鲜 IVF-ET 周期的不孕患者。根据 hCG 给药日血清 E2 水平将患者分为 6 组：第 1 组（血清 E2 水平≤1000 pg/mL，n=205）、第 2 组（血清 E2 水平 1001-2000 pg/mL，n=457）、第 3 组（血清 E2 水平 2001-3000 pg/mL，n=425）、第 4 组（血清 E2 水平 3001-4000 pg/mL，n=310）、第 5 组（血清 E2 水平 4001-5000 pg/mL，n=237）和第 6 组（血清 E2 水平>5000 pg/mL，n=137）。比较各组的获卵数和 MII 卵数、着床率和临床妊娠率，作为研究的首要目标。对于所有患者中 360 例单胎分娩的女性，计算相应受试者工作特征曲线（ROC 曲线）下的面积，以评估 E2 变化对低出生体重（LBW）婴儿概率的预测价值，作为研究的次要目标。
随着组 1 到组 5，获卵数和 MII 卵数、着床率和临床妊娠率逐渐增加，但在组 6 中下降。组 1 的参数明显差于其他组，从组 2 到组 6（获卵数，t=13.096，t=23.307，t=23.086，t=26.376，t=19.636，P<0.003；获 MII 卵数，t=10.856，t=20.868，t=21.874，t=23.374，t=19.092，P<0.003；着床率，χ²=12.179，χ²=22.239，χ²=23.993，χ²=23.344，χ²=16.758，P<0.003；临床妊娠率，χ²=16.415，χ²=28.074，χ²=35.387，χ²=37.025，χ²=24.590，P<0.003）。ROC 分析显示，当血清峰值 E2 为 3148 pg/mL 时，可预测 LBW。
结果表明，血清 E2 水平对临床结局具有浓度依赖性效应。新鲜 IVF-ET 周期中 E2 水平的最佳范围为 1000 至 3148 pg/mL。
