体外受精/卵胞浆内单精子注射治疗患者体外受精周期中获卵数和获卵率的影响因素分析

doi:10.13481/j.1671-587X.20230324

摘要/Abstract

摘要：

目的探讨体外受精/卵胞浆内单精子注射（IVF/ICSI）治疗患者体外受精周期中获卵数和获卵率的影响因素，为临床选择扳机时机提供依据。方法选择接受IVF/ICSI治疗的患者950例。采用最优尺度回归模型分析患者年龄、人绒毛膜促性腺激素（HCG）给药日雌二醇（E2）水平、卵巢储备功能、取卵日及HCG给药日不同大小卵泡百分率、促排卵方案和手术医生等因素对获卵数和获卵率的影响。结果患者年龄与获卵数呈负相关关系（β=－0.068，P<0.01），取卵日大卵泡百分率与获卵数呈负相关关系（β=－0.243，P<0.01），HCG给药日大卵泡百分率与获卵数呈负相关关系（β=－0.073，P<0.01）；HCG给药日E2水平和卵巢储备功能与获卵数呈正相关关系（β=0.270，P<0.01；β=0.196，P<0.01），HCG给药日中卵泡百分率与获卵数呈正相关关系（β=0.098，P<0.01）。促排卵方案长方案组、拮抗剂方案组、高孕激素促排卵（PPOS）方案组和自然周期方案组患者获卵数逐渐减少（β=0.227，P<0.01）。回归分析，取卵日大卵泡百分率和中卵泡百分率与获卵率呈正相关关系（β=0.168，P<0.01；β=0.194，P<0.01），卵巢储备功能、促排卵方案和不同手术医生对获卵率均有影响（β=0.086，P=0.040；β=0.137，P<0.01；β=0.270，P<0.01）。结论 HCG给药日卵泡直径≥18 mm的卵泡百分率应控制在20%以下获卵数更多；随着女性年龄增加及卵巢储备功能下降，获卵数逐渐减少；需加强取卵手术的标准操作，保证获卵率。

关键词: 体外受精, 卵胞浆内单精子注射, 获卵数, 获卵率, 雌二醇

Abstract:

Objective To discuss the influencing factors of oocytes retrieved numbers and oocytes retrieved rates during in vitro fertilization cycle in patients underwent in vitro fertilization/intracytoplasmic sperm injection（（IVF/ICSI）， and to provide the basis for the choice of the trigger time in clinical practice. Methods A total of 950 patients who received IVF/ICSI treatment were selected. The optimal scale regression model was used to analyze the effects of age， estradiol （E2） levels on the day of of human chorionic gonadotropin （HCG） administration， ovarian reserve function， percentages of different sizes of follicles on the days of oocyte retrieved and HCG administration， ovulation induction protocols of the patients， and operators on the number of oocyte retrieved and oocyte retrieved rate. Results There was a negative correlation between the age of patients and the number of oocytes retrieved（β=－0.068，P<0.01）； there was a negative correlation between the percentage of big follicles on the oocytes retrieved day and the number of oocyte retrieved（β=－0.243， P<0.01）， there was a negative correlation between the percentage of big follicles on the HCG administration day and the number of oocyte retrieved （β=－0.073，P<0.01）； there was a positive correlation between E2 levels on the HCG administration day and ovarian reserve function and the number of oocyte retrieved（β= 0.270，P<0.01；β=0.196， P<0.01）； there was a positive correlation between the percentage of middle follicles on the HCG administration day and the number of oocyte retrieved（β=0.098，P<0.01）.The numbers of oocyte retrieved of the patients in long protocol， antagonist protocol，progesterone-primed ovarian stimulation（PPOS） protocol， and natural cycle protocol were gradually decreased（β=0.227，P<0.01）. The regression analysis results showed that there were positive correlations between the percentages of big and middle follicles on the oocyte retrieved day and the rate of oocyte retrieved（β= 0.168， P<0.01；β=0.194， P<0.01）， the ovarian reserve function， ovulation induction protocol and different operators influenced the rate of oocyte retrieved（β=0.086，P=0.040；β=0.137，P<0.01； β=0.270，P<0.01）. Conclusion The percentage of follicles with diameter ≥ 18 mm on the HCG administration day should be controlled below 20%， and more oocytes should be retrieved； with the decreasing of the women’ age and ovarian reserve functions， the number of oocyte retrieved is gradually decreased； it is necessary to strengthen the standard procedures for oocyte retrieved surgery to promote the rate of oocyte retrieved.

Key words: In vitro ferilization, Intracytoplasmic sperm injection, Number of oocytes retrived, Rate of oocytes retrieved, Estradiol

中图分类号:

李仪,颜晓红,李友筑. 体外受精/卵胞浆内单精子注射治疗患者体外受精周期中获卵数和获卵率的影响因素分析[J]. 吉林大学学报(医学版), 2023, 49(3): 742-749.

Yi LI,Xiaohong YAN,Youzhu LI. Analysis on influence factors of number and rate of oocytes retrieved during in vitro fertilization cycle in patients underwent in vitro fertilization/intracytoplasmic sperm injection[J]. Journal of Jilin University(Medicine Edition), 2023, 49(3): 742-749.

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参考文献 24

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Influence factor	β	SE	P	Importance(η/%)
Age	－0.068	0.022	0.002	4.5
Type of infertility	0.002	0.011	0.830	0.1
Ovarian reserve function	0.196	0.031	<0.01	18.5
Method of trigger	0.029	0.019	0.112	1.6
Serum E2 level on trigger day	0.270	0.028	<0.01	24.6
Percentage of big follicle on oocytes retrieved day	－0.243	0.025	<0.01	22.0
Ovulation induction protocols	0.227	0.034	<0.01	20.9
Percentage of big follicle on HCG administration day	－0.073	0.034	0.010	3.7
Percentage of middle follicle on HCG administration day	0.098	0.034	<0.01	5.7
Percentage of small follicle on HCG administration day	0.012	0.017	0.571	0.2

Item	Age(year) 20	21	22	23	24	25	26	27	28	29
Frequency	3	3	5	12	23	34	40	62	83	80
Quantification value	－2.215	－2.034	－1.853	－1.672	－1.492	－1.311	－1.130	－0.949	－0.768	－0.588
Item	Age(year) 30	31	32	33	34	35	36	37	38	39
Frequency	75	62	59	55	57	60	52	30	23	17
Quantification value	－0.407	－0.226	－0.045	0.135	0.316	0.497	0.678	0.859	1.039	1.220
Item	Age(year) 40	41	42	43	44	45	46	47	48
Frequency	19	17	14	17	22	12	6	7	1
Quantification value	1.401	1.582	1.763	1.943	2.124	2.305	2.486	2.667	2.847

Group	Frequency	Quantification value
Long protocol	620	0.496
Antagonist protocol	185	－0.014
Natural cycle protocol	32	－4.049
PPOS protocol	113	－1.553

Group	Frequency	Quantification value
Ovarian reserve function
Normal	726	0.555
Low	224	1.800

Group	Frequency	Quantification value
Serum level of E2 [ρ_B/(μg·L^－1)]
114－261	8	－1.857
284－1 545	218	－1.240
1 548－2 563	197	－0.623
2 570－3 511	154	－0.006
3 533－4 546	131	0.611
4 559－5 746	191	1.228
5 832－7 968	51	1.854