本文選題：卵泡液 + 胚胎培養(yǎng)液　； 參考：《廣西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過(guò)檢測(cè)體外受精-胚胎移植（IVF-ET）患者取卵日血清、卵泡液及胚胎培養(yǎng)液中β-hCG的水平，探討其與IVF-ET臨床結(jié)局的關(guān)系。 方法：前瞻性對(duì)照研究2013年10月至2014年01月在廣西醫(yī)科大學(xué)第一附屬醫(yī)院生殖醫(yī)學(xué)研究中心第一次行IVF-ET助孕治療的68例不孕患者，均采用GnRH-a長(zhǎng)方案超促排卵。將患者隨機(jī)分為A、B兩組，A組hCG日注射hCG的劑量為6000IU，共36例；B組注射hCG的劑量為10000IU，共32例。收集患者取卵前半小時(shí)血清、取卵時(shí)的卵泡液標(biāo)本及D3胚胎移植日胚胎培養(yǎng)液，采用酶聯(lián)免疫吸附試驗(yàn)法檢測(cè)患者血清、卵泡液及胚胎培養(yǎng)液中β-hCG水平，并追蹤其獲卵數(shù)、卵母細(xì)胞受精、受精卵卵裂情況。分別將A、B兩組按血清、卵泡液中β-hCG水平的高低分組比較其臨床資料，同時(shí)按D3胚胎級(jí)別、妊娠與否、種植率的高低分組比較胚胎培養(yǎng)液中β-hCG水平，探討β-hCG水平與IVF-ET結(jié)局的關(guān)系。 結(jié)果：1.A、B兩組的獲卵數(shù)、正常受精率、卵裂率、優(yōu)胚率、妊娠率分別為14.50±5.37個(gè)、70.7%、98.7%、64.0%、58.3%和12.81±5.16個(gè)、71.7%、98.3%、65.3%、56.2%，差異均無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）。 2.A組血清β-hCG水平（170.49±38.38IU/L）明顯低于B組（296.77±32.92IU/L）（P＜0.01）；A組卵泡液β-hCG水平127.73±24.87IU/L，B組卵泡液β-hCG水平119.39±22.46IU/L，兩者無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）；A、B兩組卵泡液β-hCG水平均顯著低于血清β-hCG水平（P＜0.01）。相關(guān)性分析表明A、B兩組取卵日卵泡液β-hCG水平與血清β-hCG水平均呈顯著正相關(guān)關(guān)系（A組rs=0.737，P＜0.001；B組r=0.538，P=0.001）。 3.將A、B兩組分別按血清中不同β-hCG水平分成三小組比較（按百分位數(shù)法取臨界值，A組分界值：155.14IU/L和176.21IU/L；B組分界值：280.27IU/L和312.11IU/L）：隨著血清β-hCG水平升高，A、B兩組內(nèi)的各三小組間獲卵數(shù)、正常受精率、優(yōu)胚率及妊娠率均無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）；將A、B兩組分別按卵泡液中不同β-hCG水平分成三小組比較（A組分界值：116.56IU/L和133.71IU/L；B組分界值：106.38IU/L和122.57IU/L）：隨著卵泡液β-hCG水平的增加，A組優(yōu)胚率呈明顯增長(zhǎng)趨勢(shì)（55.4%、62.5%、73.4%），并具有顯著差異性（P=0.011），B組優(yōu)胚率亦呈增長(zhǎng)趨勢(shì)（60.5%、63.6%、70.9%），但差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 4.檢測(cè)A組內(nèi)34個(gè)I/8和B組內(nèi)33個(gè)I/8胚胎培養(yǎng)液中β-hCG水平，平均值為1.16±0.07IU/L和1.07±0.04IU/L，比較無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）；檢測(cè)A組內(nèi)15個(gè)II/8和B組內(nèi)14個(gè)II/8胚胎培養(yǎng)液中β-hCG水平，平均值為1.04±0.10IU/L和1.05±0.12IU/L，比較無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）。 5.在68例研究對(duì)象中，共有20例患者于D3所獲胚胎中同時(shí)含有I/8和II/8胚胎，胚胎培養(yǎng)液β-hCG（IU/L）水平為1.09±0.13、1.05±0.08；16例含II/8和II/6，胚胎培養(yǎng)液中β-hCG（IU/L）水平為1.04±0.13、1.12±0.05；14例含II/6和II/4，胚胎培養(yǎng)液中β-hCG（IU/L）水平為1.15±0.16、1.08±0.11，比較發(fā)現(xiàn)不同級(jí)別的胚胎培養(yǎng)液中β-hCG水平差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 6.妊娠組移植胚胎培養(yǎng)液中β-hCG水平為1.14±0.10IU/L，未妊娠組為1.09±0.04IU/L，兩組間比較有統(tǒng)計(jì)學(xué)差異（P＜0.05）；胚胎種植率分別為0%、50%、100%對(duì)應(yīng)組的胚胎培養(yǎng)液中β-hCG（IU/L）水平為1.09±0.04、1.11±0.07、1.29±0.05，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.01）。 結(jié)論：1.hCG日注射hCG劑量的高低（6000-10000IU）對(duì)IVF-ET結(jié)局無(wú)明顯影響，建議對(duì)于OHSS高危患者，可適當(dāng)減少hCG用量。 2.胚胎培養(yǎng)液中hCG水平與hCG日注射hCG的劑量及胚胎形態(tài)學(xué)評(píng)分無(wú)直接相關(guān)關(guān)系。 3.胚胎培養(yǎng)液中hCG為胚胎自身分泌，，在妊娠組及高胚胎種植率組培養(yǎng)液中hCG水平均較高，提示培養(yǎng)液中hCG水平較高的胚胎可能具有更好的發(fā)育潛能。
[Abstract]:Objective : To investigate the relationship between IVF - ET and IVF - ET in vitro fertilization - embryo transfer ( IVF - ET ) .

Methods : A prospective controlled study was conducted in 68 infertile women who underwent IVF - ET for the first time in the First Affiliated Hospital of Guangxi Medical University from October 2013 to January 2014 .
The levels of 尾 - hCG in serum , follicular fluid and embryo culture fluid were measured by enzyme - linked immunosorbent assay ( ELISA ) . The levels of 尾 - hCG in serum , follicular fluid and embryo culture fluid were measured by enzyme - linked immunosorbent assay ( ELISA ) .

Results : The number of oocytes , normal fertilization rate , cleavage rate and optimal embryo rate in group A and B were 14.50 鹵 5.37 , 70.7 % , 97.7 % , 64.0 % , 58.3 % and 12.81 鹵 5.16 , 71.7 % , 98.3 % , 65.3 % and 56.2 % , respectively , with no statistical difference ( P > 0.05 ) .

2 . Serum 尾 - hCG level in group A ( 170.49 鹵 38.38IU / L ) was significantly lower than that in group B ( 296.77 鹵 32.92IU / L ) ( P < 0.01 ) .
The levels of 尾 - hCG in group A were 127.73 鹵 24.87IU / L and 119.39 鹵 22.46IU / L , respectively . There was no statistical difference between the two groups ( P > 0.05 ) .
The levels of 尾 - hCG in both groups A and B were significantly lower than that in serum 尾 - hCG ( P < 0.01 ) . The correlation analysis showed that the levels of 尾 - hCG and 尾 - hCG in both groups A and B were positively correlated with the serum 尾 - hCG level ( group A rs = 0.737 , P < 0.001 ) .
B緇剅=0.538,P=0.001).


3 . A group A and B were divided into three groups according to different levels of 尾 - hCG in serum ( the critical value was obtained according to the percentage of percentile ) , the value of A was 155.14IU / L and 176.21IU / L .
B - component bound values : 280.27IU / L and 312.11IU / L ) : With the increase of serum 尾 - hCG level , there was no statistical difference between the three groups in both groups A and B ( P > 0.05 ) .
Group A and group B were divided into three groups according to the levels of 尾 - hCG in the follicular fluid ( A : 1160.56 IU / L and 133.71IU / L ) .
The B - component bound values : 106 . 38IU / L and 122 . 57IU / L ) : with the increase of 尾 - hCG level in the follicular fluid , the percentage of excellent embryo in group A was significantly increased ( 55.4 % , 62.5 % , 73.4 % ) , and there was a significant difference ( P = 0 . 011 ) , and that of group B was also increased ( 60.5 % , 63.6 % , 70.9 % ) , but there was no statistical significance ( P > 0.05 ) .

4 . The levels of 尾 - hCG in 33 I / 8 and group B of 34 I / 8 and group B in group A were measured , the mean value was 1.16 鹵 0.07 IU / L and 1.07 鹵 0.04 IU / L , there was no statistical difference ( P > 0.05 ) .
The average value of 尾 - hCG was 1.04 鹵 0.10 IU / L and 1.05 鹵 0.12 IU / L in 15 II / 8 and B group ( P > 0.05 ) .

5.The 尾 - hCG ( IU / L ) levels were 1.09 鹵 0.13 , 1.05 鹵 0.08 , respectively .
The levels of 尾 - hCG ( IU / L ) were 1.04 鹵 0.13 , 1.12 鹵 0.05 in 16 cases containing II / 8 and II / 6 .
The levels of 尾 - hCG ( IU / L ) were 1.15 鹵 0.16 and 1.08 鹵 0.11 respectively in 14 cases containing II / 6 and II / 4 , and there was no significant difference between 尾 - hCG levels in different grades of embryo culture fluid ( P > 0.05 ) .

6 . The 尾 - hCG level was 1.14 鹵 0.10 IU / L in the pregnant group and 1.09 鹵 0.04 IU / L in the unpregnant group ( P < 0.05 ) .
The rates of 尾 - hCG ( IU / L ) were 1.09 鹵 0.04 , 1.11 鹵 0.07 and 1.29 鹵 0.05 respectively in the embryo culture medium of 0 % , 50 % and 100 % , respectively . The difference was statistically significant ( P < 0.01 ) .

Conclusion : 1 . The high level of hCG injection ( 6000 - 10000IU ) has no obvious effect on the outcome of IVF - ET , and it is suggested that the amount of hCG can be reduced due to OHSS high - risk patients .

2 . There was no direct correlation between the hCG level in the embryo culture fluid and the dose of hCG injected with hCG on the day of hCG injection and the embryonic morphology score .

3 . The hCG in the embryo culture medium is secreted by the embryo itself , and the hCG level in the culture fluid of the pregnancy group and the high - embryo implantation rate group is higher , suggesting that the embryo with higher hCG level in the culture medium may have better development potential .
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R714.8

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