雌二醇（）降低会对体外受精和胚胎移植（IVF-ET）的胚胎质量和临床结局产生不利影响。
Estradiol ( ) Reduction Adversely Affect the Embryo Quality and Clinical Outcomes of In Vitro Fertilization and Embryo transfer (IVF-ET).
机构信息
Reproductive Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
出版信息
J Healthc Eng. 2022 Apr 7;2022:2473876. doi: 10.1155/2022/2473876. eCollection 2022.
OBJECTIVE
The purpose of this study was to explore the influence of decreased serum estradiol ( ) levels during controlled ovarian hyperstimulation (COH) on in vitro fertilization and embryo transfer (IVF).
METHODS
The clinical data of 300 IVF-ET cycles with patients were analyzed retrospectively. According to the presence of falling level during the COH, we divided all subjects into two groups: the levels fall group ( = 120, group A) and the control group ( = 180, group B). In group A, there were 57 patients with falling with drug dosage reduction. The other 63 patients experienced the decreased level spontaneously. The clinical and laboratory variables in the groups were compared. Receiver operator characteristic (ROC) curve analyses were carried out in order to evaluate the predict value of level on the day of human chorionic gonadotropin (hCG) administration on IVF outcomes.
RESULTS
Duration and total dosage of gonadotropin (Gn) used were statistically more in group A than in group B ( < 0.001). The high-quality embryo rate was significantly lower in group A ( = 0.048). Women in group A had lower clinical pregnancy rate ( = 0.029), live birth rate ( < 0.001), ongoing pregnancy rate ( = 0.001), and higher early abortion rates ( = 0.008) than group B. Women with spontaneously falling group had a higher BMI index than those in the drug dosage reduction group ( = 0.001). More dosage and longer duration of Gn in spontaneously falling group than in the drug dosage reduction group ( < 0.01). There were no differences in clinical outcomes between the two types of decreased groups. Results from ROC showed an level <1987.5 pg/ml on the hCG day might predict early abortion in this study. The sensitivity was 58.4% and the specificity was 78.9%. In addition, an level >2020 pg/ml on the hCG day might be an index to predict live birth. The sensitivity was 57.0% and the specificity was 61.7%.
CONCLUSIONS
Reduction of during COH might adversely affect the clinical pregnancy, early abortion, and ongoing pregnancy of IVF-ET.
目的
本研究旨在探讨控制性卵巢过度刺激（COH）过程中血清雌二醇（）水平降低对体外受精和胚胎移植（IVF）的影响。
方法
回顾性分析 300 例接受 IVF-ET 治疗的患者的临床资料。根据 COH 过程中是否存在下降水平，将所有受试者分为两组：下降组（=120，A 组）和对照组（=180，B 组）。A 组中，有 57 例因药物剂量减少而出现下降水平，另外 63 例则为自然下降。比较两组的临床和实验室变量。进行受试者工作特征（ROC）曲线分析，以评估 hCG 日血清水平对 IVF 结局的预测价值。
结果
A 组的促性腺激素（Gn）使用时间和总剂量明显长于 B 组（<0.001）。A 组的优质胚胎率显著低于 B 组（=0.048）。A 组的临床妊娠率（=0.029）、活产率（<0.001）、持续妊娠率（=0.001）较低，早期流产率（=0.008）较高。与药物剂量减少组相比，自然下降组的体重指数（BMI）指数更高（=0.001）。自然下降组 Gn 的用量和使用时间均长于药物剂量减少组（<0.01）。两种下降类型组的临床结局无差异。ROC 结果显示，hCG 日血清水平<1987.5 pg/ml 可能预示着本研究中的早期流产。其灵敏度为 58.4%，特异性为 78.9%。此外，hCG 日血清水平>2020 pg/ml 可能是预测活产的指标。其灵敏度为 57.0%，特异性为 61.7%。
结论
COH 过程中雌二醇水平降低可能会对 IVF-ET 的临床妊娠、早期流产和持续妊娠产生不良影响。
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