Clinical Study on the Correlation between "Seven-Five-Three" Odd Number Regular Pattern by National Distinguished Master Xia Guicheng and the Trigger Timing of in vitro Fertilization-Embryo Transfer
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摘要: 目的 观察体外受精/卵胞浆内单精子注射-胚胎移植(In vitro fertilization/Intracytoplasmic sperm injection-embryo transfer, IVF/ICSI-ET)长方案周期中最佳扳机日是否与国医大师夏桂成教授提出的“7、5、3奇数律”相符, 以及对卵泡及胚胎发育情况及妊娠结局的影响。方法 回顾性分析426例因女方因素首次接受IVF/ICSI-ET长方案周期, 根据促性腺激素(Gonadotropin, Gn)启动日至扳机日是否符合“7、5、3奇数律”, 分为数律扳机组与非数律扳机组, 比较Gn天数、Gn用量及获卵率、受精率、2原核(2 Pronucleus, 2PN)率、可移植胚胎率、临床妊娠率、活产率等。结果 ① 按“7、5、3奇数律”扳机组186例, 其获卵率、2PN率、可移植胚胎率、临床妊娠率、活产率均显著高于非数律扳机组(P < 0.05, P < 0.01)。②3数律亚组中, 按数律扳机组受精率显著高于非数律扳机组(P < 0.01);5数律亚组中, 按数律扳机组Gn天数及Gn总量显著低于非数律扳机组(P < 0.01), 按数律扳机组获卵率、可移植胚胎率、临床妊娠率均显著高于非数律扳机组(P < 0.05, P < 0.01);7数律亚组中, 按数律扳机组可移植胚胎率显著高于非数律扳机组(P < 0.05)。结论 国医大师夏桂成教授提出的“7、5、3奇数律”适用于IVF/ICSI-ET长方案周期扳机日的确立, 按7、5数律扳机可提高可移植胚胎率, 5数律扳机可升高临床妊娠率与活产率, 3数律扳机可增加受精率。Abstract: OBJECTIVE To observe whether the optimal trigger day in in vitro fertilization/intra cytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) long protocol cycles is conformed to the "seven-five-three" odd number regular pattern by national distinguished master Xia Guicheng, as well as its effect on follicular and embryonic development and pregnancy outcome.METHODS A total of 426 cases who underwent IVF/ICSI-ET for the first time due to female factor, they were divided into numerical trigger group and non-numerical trigger group according to whether the gonadotropin (Gn) initiation date to the trigger date conformed to the seven-five-three odd number regular pattern. In addition, we compared the Gn days, Gn dosage, egg acquisition rate, fertilization rate, 2 pronucleus (2 PN) rate, transferable embryo rate, clinical pregnancy rate, and live birth rate.RESULTS ① The egg acquisition rate, 2PN rate, transferable embryo rate, clinical pregnancy rate and live birth rate of 186 cases in the seven-five-three odd number regular pattern trigger group were significantly higher than those in the non-numerical trigger group (P < 0.05, P < 0.01). ②As to "three" regular pattern subgroup, the fertilization rate was significantly higher in the numerical trigger group than that in the non-numerical trigger group (P < 0.01); As to "five" regular pattern subgroup, the Gn days and the total number of Gn in the numerical trigger group were significantly lower than those in the non-numerical trigger group (P < 0.01); The egg acquisition rate, embryo transferability rate and clinical pregnancy rate were significantly higher in the numerical trigger group than those in the non-numerical trigger group (P < 0.05, P < 0.01); As to "seven" regular pattern subgroup, the embryo transferability rate in the numerical trigger group was significantly higher than that in the non-numerical trigger group (P < 0.05).CONCLUSION The seven-five-three odd number regular pattern proposed by Xia Guicheng, a national distinguished master, is applicable to the establishment of the trigger day of IVF/ICSI-ET long protocol cycle, and the transferable embryo rate can be improved by the seven and five regular pattern triggers. In addition, the five regular pattern trigger can increase the clinical pregnancy and live birth rates, and the three regular pattern trigger can increase the fertilization rate.
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表 1 2组基线资料比较(x±s)
分组 例数 年龄/岁 BMI/(kg·m-2) 不孕年限/a FSH/(mU·mL-1) LH/(mU·mL-1) E2/(ng·L-1) T/(ng·dL-1) 数律扳机组 186 29.40±3.52 22.78±3.20 2.82±1.68 6.93±1.83 6.79±3.26 45.96±15.70 49.84±22.91 非数律扳机组 240 29.54±3.71 22.73±3.35 2.86±1.95 6.77±2.03 7.27±4.57 46.35±21.27 52.37±32.68 注: BMI.体质量指数; FSH.促卵泡生成素; E2.雌二醇; T.睾酮 表 2 2组卵泡及胚胎发育情况比较(x±s)
分组 例数 Gn天数/d Gn总量/U 获卵率/% 受精率/% 2PN率/% 可移植胚胎率/% 数律扳机组 186 10.29±2.29 2 248.16±638.02 79.98**(1 446/1 808) 78.42(1 134/1 446) 73.65**(1 065/1 446) 56.04**(566/1 010) 非数律扳机组 240 10.51±1.89 2 162.61±556.12 73.00(1 682/2 304) 76.10(1 280/1 682) 67.66(1 138/1 682) 49.62(527/1 062) t或χ2 1.09 1.48 27.07 2.38 13.41 8.55 注: 2组比较, **P < 0.01。 表 3 3数律亚组卵泡及胚胎发育情况比较(x±s)
分组 例数 Gn天数/d Gn总量/U 获卵率/% 受精率/% 2PN率/% 可移植胚胎率/% 3数律扳机组 42 10.14±2.02 2 091.12±558.62 75.82(348/459) 83.05**(289/348) 79.89(278/348) 46.34(95/205) 非3数律扳机组 51 9.82±2.64 1 964.22±487.22 73.76(357/484) 71.71(256/357) 73.95(264/357) 48.55(117/241) t或χ2 0.65 1.17 0.53 12.91 3.49 0.22 注: 组间比较, **P < 0.01。 表 4 5数律亚组卵泡及胚胎发育情况比较(x±s)
分组 例数 Gn天数/d Gn总量/U 获卵率/% 受精率/% 2PN率/% 可移植胚胎率/% 5数律扳机组 78 10.26±2.04** 2 025.96±511.64** 88.42**(626/708) 77.00(482/626) 73.64(461/626) 60.54*(290/479) 非5数律扳机组 76 11.53±1.31 2 416.11±564.32 70.32(533/758) 77.49(413/533) 69.23(369/533) 52.14(183/351) t或χ2 4.58 4.50 72.45 0.039 2.76 5.84 注: 组间比较, *P < 0.05,**P < 0.01。 表 5 7数律亚组卵泡及胚胎发育情况比较(x±s)
分组 例数 Gn天数/d Gn总量/U 获卵率/% 受精率/% 2PN率/% 可移植胚胎率/% 7数律扳机组 66 12.68±1.47** 2 571.67±533.75** 73.63(472/641) 76.91(363/472) 69.07(326/472) 55.52*(181/326) 非7数律扳机组 113 10.96±1.69 2 285.80±623.72 74.58(792/1 062) 77.15(611/792) 63.76(505/792) 48.30(227/470) t或χ2 6.88 3.12 0.19 0.01 3.70 4.02 注: 组间比较, *P < 0.05,**P < 0.01。 表 6 2组妊娠结局比较
分组 例数 临床妊娠 流产 活产 双胎 减胎 数律扳机组 186 85* 5 80 17 0 非数律扳机组 240 86 7 79 13 3 χ2 4.25 0.02 4.56 2.22 2.34 注: 组间比较, *P < 0.05。 表 7 3数律亚组妊娠结局比较
分组 例数 临床妊娠 流产 活产 双胎 减胎 数律扳机组 42 19 1 18 3 0 非数律扳机组 51 20 1 19 1 0 χ2 0.34 0.019 0.30 1.50 - 表 8 5数律亚组妊娠结局比较
分组 例数 临床妊娠 流产 活产 双胎 减胎 数律扳机组 78 36* 3 33 8 0 非数律扳机组 76 23 2 21 4 0 χ2 4.11 0.18 3.64 1.34 - 注: 2组比较, *P < 0.05。 表 9 7数律亚组妊娠结局比较
分组 例数 临床妊娠 流产 活产 双胎 减胎 数律扳机组 66 30 1 29 6 0 非数律扳机组 113 43 4 39 8 3 χ2 0.95 0.63 1.57 0.23 1.78 -
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