依据扳机日血清E2值制定HCG剂量对ICSI结局的影响

目的 探讨依据扳机日血清E2值制定HCG剂量对卵胞浆内单精子注射（ICSI）促排卵结局的影响。方法 前瞻性分析2012年1－12月在上海瑞金医院生殖中心行ICSI助孕依据HCG日血清E2值制定不同HCG扳机剂量的117名患者的促排卵结局。HCG扳机剂量制定原则：E2值≤16 515 pmol/L为7000 IU、E2值介于16 516～23 854 pmol/L为5000 IU、E2值≥23 855 pmol/L为3000 IU。结果 3组MⅡ率、受精率的差异无统计学意义。7000 IU组卵裂率低于5000 IU组（96.43% vs. 99.62%），差异有统计学意义（P<0.05），7000 IU组可用胚胎率高于3000 IU组和5000 IU组（65.43% vs.55.69%和57.74%），差异有统计学意义（P<0.05）。5000 IU组发生1例中度OHSS。3组新鲜移植周期的平均移植胚胎数、临床妊娠率和胚胎着床率的差异无统计学意义。结论 依据HCG日E2值制定HCG扳机剂量不影响卵母细胞成熟率和妊娠率，即高E2值予以低剂量HCG，低E2值予以高剂量HCG的原则是可行的。

The effect of different doses of HCG on ICSI outcomes: according to serum E2 level on HCG day.

Abstract： Objective To discuss the effect of different HCG doses according to serum E2 level on HCG day for triggering final oocyte maturation on ICSI outcomes. Methods This was a prospective study including 117 couples with an indication for ICSI between Jan. 2012 and Dec. 2012 at Reproductive Center of Ruijin Hospital. The dose of HCG for final oocyte maturation was used according to serum E2 level on HCG day as follows: if serum E2 concentration was ≤16 515 pmol/L, the dose of HCG was 7000 IU, serum E2 concentration ranged from 16 516 pmol/L to 23 854 pmol/L, the dose of HCG was 5000 IU, serum E2 concentration was ≥23 855 pmol/L, the dose of HCG was 3000 IU. The outcomes of three groups were compared. Results There were no significant differences among three groups on MⅡ rate and fertilization rate. The cleavage rate of 7000 IU group was significantly lower than 5000 IU group (96.43% vs. 99.62%). But the viability embryo rate of 7000 IU group was significantly higher than both 3000 IU group and 5000 IU group (65.43 vs. 55.69% and 57.74%, respectively). There was one moderate OHSS patient in 5000 IU group. There were no significant differences among three groups on mean number of embryo transfer, clinical pregnancy rate and implantation rate in fresh embryo-transfer cycles. Conclusion Using different doses of HCG according to serum E2 level on HCG day to trigger final oocyte maturation does not affect oocyte maturation and pregnancy rate. The principle that patient with high E2 concentration was given lower HCG dose and patient with low E2 concentration was given higher HCG dose was available.