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目的:探讨在IVF/ICSI-ET周期中患者基础促甲状腺激素(thyroid stimulating hormone,TSH)水平与临床妊娠结局的关系。方法:回顾性分析第1次行IVF/ICSI-ET不孕患者的促排卵结局与TSH的相关性。结果:①在1 832个IVF/ICSI周期中,TSH与PRL水平呈正相关(r=0.080,P=0.002),而与获卵数、受精卵子数、受精率、可移植胚胎数、优质胚胎数、孕囊与心芽搏动数、种植率、生化妊娠率、流产率、活产率无明显相关性(P>0.05);PRL与获卵数呈正相关(r=-0.050,P=0.032),但不影响后期的受精、可移植胚胎数、优质胚胎数、着床及后期的生化妊娠率、临床妊娠率及活产率。控制PRL后对TSH本身与获卵数行相关性分析,结果两者间无相关性(r=0.004,P=0.874)。②分别比较不同TSH界值下高于界值与低于界值组的获卵数、受精卵子数、受精率、可移植胚胎数、优质胚胎数、孕囊与心芽搏动数、种植率的情况,结果界值上、下组间实验室及临床相关指标无明显差异。但当TSH界值分别为2.7 mIU/L、3.3 mIU/L、3.9 mIU/L时,低、高组间的活产率分别为83.1%和81.0%,82.3%和78.9%,83.9%和70.3%,流产率分别为16.1%和19.0%,17.7%和21.1%,16.1%和19.7%,虽未达到统计学差异,但低水平TSH组的流产率较高水平TSH组相对较低,活产率较高,并随着界值的增大,界值上、下组间的活产率与流产率差距增大。结论:在0.3~4.2 mIU/L区间,TSH水平对于IVF/ICSI-ET的妊娠结局无明显影响。当基础TSH水平>2.7 mIU/L时,流产率有上升趋势,活产率有下降趋势,需对孕妇孕期情况进行密切随访。
Objective: To investigate the relationship between the level of thyroid stimulating hormone (TSH) and the outcome of clinical pregnancy in IVF / ICSI-ET cycles. Methods: The correlation between ovulation induction and TSH in the first IVF / ICSI-ET infertility patients was retrospectively analyzed. Results: ①There was a positive correlation between TSH and PRL level in 1 832 cycles of IVF / ICSI (r = 0.080, P = 0.002), but not related to number of oocytes retrieved, number of fertilized eggs, fertilization rate, number of transferable embryos, (P> 0.05). There was a positive correlation between PRL and the number of oocytes retrieved (r = -0.050, P = 0.032), while the rate of pregnancy rate, But does not affect the late fertilization, the number of transplanted embryos, the number of high-quality embryos, implantation and post-biochemical pregnancy rates, clinical pregnancy rates and live births. There was no correlation between the TSH itself and the number of ova retrieved after PRL control (r = 0.004, P = 0.874). ② Comparison of the numbers of oocytes, fertilized eggs, fertilized eggs, number of fertile embryos, number of high-quality embryos, number of gestational sacs and cardiac spikes, implantation rate under the different TSH thresholds Situation, the results of the cut-off value, the lower group of laboratory and clinically relevant indicators no significant difference. However, when the TSH cutoff values were 2.7 mIU / L, 3.3 mIU / L and 3.9 mIU / L, the live birth rates were 83.1% and 81.0%, 82.3% and 78.9%, 83.9% and 70.3 % And abortion rate were 16.1% and 19.0%, 17.7% and 21.1%, 16.1% and 19.7%, respectively. Although the difference was not reached, the abortion rate in the low-level TSH group was relatively lower than that in the high-level TSH group, and the live birth rate Rate is higher, and with the increase of cut-off value, the gap between live birth rate and abortion rate increases. CONCLUSION: TSH levels have no significant effect on IVF / ICSI-ET pregnancy outcome in the range of 0.3-4.2 mIU / L. When the basal TSH level is> 2.7 mIU / L, the abortion rate has an upward trend and the live birth rate has a downward trend. The pregnancy status of pregnant women needs to be closely followed up.