Feichtinger Michael, Karlström Per O, Olofsson Jan I, Rodriguez-Wallberg Kenny A
Reproductive Medicine, Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
Department of Obstetrics and Gynecology, Division of Gynecologic Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria.
Acta Obstet Gynecol Scand. 2017 Dec;96(12):1423-1429. doi: 10.1111/aogs.13235. Epub 2017 Oct 31.
Scheduling of ovum pickup only on weekdays may result in cases of apparently suboptimal timing for human chorionic gonadotropin and ovum pickup. This study aimed to assess whether live-birth rates were reduced in women with a potentially suboptimal day for human chorionic gonadotropin and ovum pickup to avoid weekend work, according to ultrasonographic data on the day of human chorionic gonadotropin planning.
An evaluation of the optimal human chorionic gonadotropin priming date was performed in treatment protocols of 1000 consecutive patients undergoing their first in vitro fertilization/intracytoplasmatic sperm injection with single-embryo transfer. An ideal ovum pickup day was characterized by human chorionic gonadotropin-scheduling when three or more follicles reached 17 mm (day 0) or with one day of delay (day +1) (n = 760). A non-ideal ovum pickup was either early (day -1, -2, -3) (n = 24) or delayed (day +2, +3, +4) (n = 216). Live-birth rates in the ideal and non-ideal ovum pickup groups was set as primary outcome measure.
Early-ovum pickups were excluded as they were infrequent. No differences between ideal and delayed ovum pickup groups were found regarding number of oocytes retrieved (9.87 vs. 9.78, p = 0.990), pregnancy rates (28.3% vs. 29.6%, p = 0.701) or live-birth rates (26.2% vs. 25.9%, p = 0.939). However, sub analyses indicated that treatment with gonadotropin releasing hormone antagonists resulted in significantly lower clinical pregnancy rates in delayed ovum pickups (odds ratio 0.46, p = 0.014), compared with agonist treatments.
Weekend work may not be needed for in vitro fertilization/intracytoplasmatic sperm injection single-embryo transfer treatments. However, in gonadotropin releasing hormone antagonist cycles, delaying ovum pickup more than one day may result in unfavorable outcomes.
仅在工作日安排取卵可能会导致人绒毛膜促性腺激素(hCG)注射和取卵时机明显欠佳的情况。本研究旨在根据hCG注射当天的超声数据,评估因避免周末工作而导致hCG注射和取卵时机潜在欠佳的女性的活产率是否降低。
对1000例连续接受首次体外受精/卵胞浆内单精子注射并进行单胚胎移植的患者的治疗方案进行最佳hCG启动日期评估。理想的取卵日的特征是,当三个或更多卵泡达到17毫米时(第0天)或延迟一天(第+1天)进行hCG注射(n = 760)。不理想的取卵要么过早(第-1、-2、-3天)(n = ),要么延迟(第+2、+3、+4天)(n = 216)。理想和不理想取卵组的活产率被设定为主要结局指标。
由于过早取卵情况罕见,故将其排除。在获取的卵母细胞数量(9.87对9.78,p = 0.990)、妊娠率(28.3%对29.6%,p = 0.701)或活产率(26.2%对25.9%,p = 0.939)方面,理想和延迟取卵组之间未发现差异。然而,亚组分析表明,与激动剂治疗相比,使用促性腺激素释放激素拮抗剂治疗导致延迟取卵时临床妊娠率显著降低(优势比0.46,p = 0.014)。
体外受精/卵胞浆内单精子注射单胚胎移植治疗可能无需在周末工作。然而,在促性腺激素释放激素拮抗剂周期中,取卵延迟超过一天可能会导致不良结局。 (注:原文中“过早取卵情况罕见,故将其排除”处“n = ”原文有误,未给出具体数字)