| Objective:The analysis starts from the analysis of the embryo implantation rate,abortion rate,clinical pregnancy rate,and live birth rate of fresh cycle transplantation in in Vitro Fertilization（IVF）/Intracytoplasmic Sperm Injection（ICSI）.To investigate the serum progesterone（P4）,progesterone-oocyte-index（POI）,estradiol（E2）,and Luteinizing Hormone（LH）levels of Human Chorionic Gonadotropin（HCG）trigger day on IVF/ICSI pregnancy outcome and their predictive value.Methods:A total of 932 cases of infertile women who performed the long-term Controlled Ovarian Hyper-stimulation（COH）HCG trigger of Gonadotropin-Releasing Hormone Agonist（Gn RH-a）in Northen Jiangsu People Hospital from January 2012 to January 2019 were studied.According to the serum P4（ng/L）level on HCG day,it was divided into 3 groups:A1:P4<1.0,A2:1.0≤P4<1.5,A3:P4≥1.5.According to the HCG day POI value,it is divided into 2 groups:B1:POI≤0.17,B2:POI>0.17.According to the serum E2（pg/m L）level on HCG day,it was divided into 6 groups:C1:E2<1000,C2:1000≤E2<2000,C3:2000≤E2<3000,C4:3000≤E2<4000,C5:4000≤E2<500,C6:E2≥5000.According to the level of single follicle on day of HCG（the number of oocyte≥14mm）,E2level was divided into 5 groups:D1:E2<100,D2:100≤E2<200,D3:200≤E2<300,D4:300≤E2<400,D5:E2≥400.Divided into two groups according to the LH（IU/L）level on HCG day:E1:LH<1.21,E2:LH≥1.21.SPSS 19.0 statistical software was used for data analysis.The data were described by mean,standard deviation and rate.The ANOVA,multivariate logistic regression analysis,t-test,χ2test and ROC curve analysis value were used for statistical analysis.Result:A total of 932 cases of IVF/ICSI fresh cycle were included in this clinical study.Among them,359 cases of clinical pregnancy were obtained,the total clinical pregnancy rate was 38.5%;345 cases of intrauterine pregnancy,the rate of intrauterine pregnancy was 96.1%;14 cases of ectopic pregnancy,the rate of ectopic pregnancy was3.8%;28 cases of multiple pregnancy,multiple pregnancy rate of 7.8%;56 cases of spontaneous abortion,abortion rate was 15.6%.The number of live births was 346,and the live birth rate was 37.1%;the number of pregnant sacs was 422,the number of transferred embryos is 1645,and the embryo implantation rate is 25.7%.1.Serum P4（ng/L）level on HCG day was groupedThe total GN,the number of follicles on trigger day and the number of oocytes in A3（P4≥1.5）group were higher than those in A1（P4<1.0）group,A2（1.0≤P4<1.5）group,the difference was significant（P<0.05）.The implantation rate of A3 was 15.87%（156/983）,clinical pregnancy rate was 22.53%（121/537）,clinical live rate was21.04%（113/537）,which was significantly lower than that of the other two groups（P<0.05）;the abortion rate of A3 was 26.45%（32/121）,which was significantly higher than that of A1 group（P<0.05）.2.POI on HCG day was groupedThere were differences between the two groups in the general clinical total GN,the number of follicles on trigger day,the number of oocytes obtained,and the level of basic E2and LH（P<0.05）.The embryo implantation rate was 52.07%（340/653）,the clinical pregnancy rate was 66.21%（239/361）,the clinical live rate was 80.61%（291/361）significantly higher than that of B2（POI>0.17）group,and the abortion rate was 12.13%（33/272）significantly lower than the B2（POI>0.17）group（P<0.05）.3.Serum E2（pg/m L）level on HCG day was grouped There were differences between the groups in total GN,the number of follicles on trigger day,and the number of oocytes obtained,（P<0.05）.The embryo implantation rate,clinical pregnancy rate and clinical live birth rate of C2（1000≤E2<2000）group were 32.97%（183/555）,47%（149/317）and 50.79%（161/317）respectively,ranking first in six groups,significantly higher than those of other three groups with E2≥3000,the difference was statistically significant（P<0.05）;the abortion rate of C1（E2<1000）group was the highest,28.79%（19 66）,but the difference between groups was not statistically significant.4.The E2（pg/m L）level of single follicle（≥14mm egg number）on h CG day was groupedThere were differences between the two groups in total GN,the number of follicles on trigger day,the number of oocytes obtained,and the level of basic E2and LH（P<0.05）.The embryo implantation rate,clinical pregnancy rate and clinical live birth rate of D2（100≤E2<200）group were 58.35%（262/449）,82.42%（211/256）and 88.67%（227/256）respectively,ranking first in five groups,significantly higher than those of other three groups with E2≥300,the difference was statistically significant（P<0.05）.The abortion rate in D1（E2<100）group was 81.23%（13/16）significantly higher than that in the other four groups（P<0.05）.5.Serum LH（IU/L）level on HCG day was groupedThere were differences between the two groups in the general clinical total G N,the number of follicles on trigger day,and the number of oocytes obtained,（P<0.05）.The embryo implantation rate of E1（LH<1.21）group was 10.16%（62/610）,The clinical pregnancy rate was 14.33%（49/342）,The clinical live birth rate was 8.77%（30/342）significantly lower than that of E2（LH≥1.21）g roup,and the abortion rate was 48.98%（24/49）significantly higher than that of E2（LH≥1.21）group（P<0.05）.Conclusion:1.When the serum P<1.5ng/L and POI≤0.17 on HCG trigger day are IVF/ICSI,a better clinical pregnancy outcome can be obtained.And the area under ROC curve shows that POI value of trigger day is more predictive than P4value.2.When the total serum E2level is 1000pg/ml≤E2<3000pg/ml,and the single follicle E2level is100PG/ml≤E2<200pg/ml,the clinical pregnancy rate and live birth rate increased significantly.The area under ROC curve showed that the E2level of single follicle was more predictive than the total E2level.3.IVF/ICSI can achieve better clinical pregnancy outcome when the serum LH level of HCG trigger day is≥1.21.4.Fresh embryo transfer is not feasible when the total E2of HCG trigger day is≥4000pg/ml or the E2of single follicle is≥300pg/ml.it is suggested that whole embryo freezing should be considered. |
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