标题：外源性补充戊酸雌二醇在体外受精-胚胎移植治疗中的意义

      作者：邹红艳，王细林，吴方贵，彭南妮
    （深圳市罗湖区人民医院生殖医学中心，广东 深圳 518000）

      卷次： 2013年24卷10期

      【摘要】 目的 探讨移植后7 d雌激素水平下降及其幅度对体外受精-胚胎移植(IVF-ET)妊娠结局的影响，
观察外源性补充雌激素后能否改善其结局。方法 采用回顾性分析研究，选择2009年1~11月及2010年1~11月
共772个 IVF-ET或卵胞浆单精子注射(ICSI)助孕周期，所有病例均采用标准长方案。其中2009年399个周期移
植后7 d不补充戊酸雌二醇作为对照组，2010年373个周期作为实验组，移植7 d后常规检测E2，与注射绒毛膜促
性腺激素(HCG)当天的E2比值；将对照组 399个周期与实验组 373个周期均按E2下降的幅度分为A组(51%~
100%)、B组(31%~50%)、C组(10%~30%)和D组(<10%)，然后实验组A、B组补充戊酸雌二醇3 mg/d，C、D组补充戊
酸雌二醇6 mg/d，对照组则不补充，比较各组间临床妊娠率、流产率、获卵数和胚胎移植日内膜厚度。结果 (1)实
验组与对照组各组间及其各亚组间临床妊娠率比较差异无统计学意义(P>0.05)；(2) C、D两组即E2大幅下降实验
组较对照组流产率明显下降，差异有显著统计学意义(P<0.01)；对照组内分析，D组，即E2下降幅度最大组流产
率显著增加(P<0.05)；(3)实验组与对照组各组间及各亚组间获卵率、子宫内膜厚度差异无统计学意义(P>
0.05)。结论 (1) E2下降及其幅度与获卵数、ET日的内膜厚度不相关，不影响临床妊娠率，外源补充戊酸雌二醇
对改善临床妊娠率意义不大；(2) E2水平大幅度下降，流产率增加，补充外源性E2对此有改善；(3)服用戊酸雌二
醇组未见畸形率增加，其在孕早期是安全的。

      【关键词】 体外受精-胚胎移植；雌激素；戊酸雌二醇

      【中图分类号】 R714.13 【文献标识码】 A 【文章编号】 1003—6350(2013)10—1443—03


Significance of exogenous supplementation of pentanoic acid estradiol during IVF-ET.
ZOU Hong-yan, WANG
Xi-lin,WU Fang-gui, PENG Nan-ni. Reproductive Medical Center, People's Hospital of Luohuo District of Shenzhen City,
Shenzhen 518000, Guangdong, CHINA

【Abstract】 Objective To explore the effect of the decline and amplitude of estrogen levels on pregnancy
outcome 7 days after in vitro fertilization and embryo transfer (IVF/ET), and to investigate whether exogenous supple-
mentation of estrogen could improve the outcome. Methods A total of 772 IVF or ICSI cycles from January to No-
vember in 2009 (399 cycles, the control group) and from January to November in 2010 (373 cycles, the study group)
were retrospectively analyzed. All cases adopt standard long Protocol. The control group received no pentanoic acid es-
tradiol 7 days after IVF/ET, while the study group received pentanoic acid estradiol. The ratio of the E2 value 7 days
after IVF/ET to that on the day of HCG injected was calculated. According to the ratio, the control group and the study
group were further divided into subgroup A (50%~100%), subgroup B (30%~50%), subgroup C (10%~30%), sub-
group D (<10%), respectively. Subgroup A, B of the study group added pentanoic acid estradiol 3 mg/d, subgroup C,
D added pentanoic acid estradiol 6 mg/d. The four subgroups of the control group received no pentanoic acid estradiol.
The clinical pregnancy rate, abortion rate, the egg number, and endometrial thickness on the day of IVF/ET were com-
pared. Results (1) The clinical pregnancy rate showed no statistically significant difference between the study group
and the control group, as well as between the corresponding subgroups (P>0.05). (2) The abortion rate in subgroup D
of the control group was significantly higher than subgroup A, B, C of the control group (P<0.05), while the abortion
rate in subgroup C, D of the study group was significantly lower than the control group (P<0.01). (3) The egg recovery
rate, endometrial thickness showed no statistically significant difference between the groups and subgroups (P>0.05).
Conclusion (1) The decline and amplitude of estrogen levels on ET day has nothing to do with egg recovery rate, en-
dometrial thickness, and does not affect clinical pregnancy rate. (2) E2 levels on ET day dropped substantially, the
abortion rate increases, the added exogenous E2 could improve the outcome. (3) Supplementation of pentanoic acid es-
tradiol did not increase deformity rate, which has good safety in early stages of pregnancy.