Correlation Analysis Of Estradiol And Its Daily Rising Rate In Different Stages Of IVF-ET Process With Pregnancy-assisted Outcome

Objective:With the raid development of assisted reproductive technology,the clinical pregnancy rate of infertile patients has been greatly improved,about 40～50%,but how to improve the clinical pregnancy rate is still an important medical problem that clinicians need to solve.At present,many scholars have analyzed progesterone（P）level,estradiol（E₂）level,HCG level and other related factors that may affect the outcome of assisted pregnancy to predict the outcome of IVF.The purpose of this study is to analyze the embryotransfer of fresh embryos In vitro fertilization embryotransfer（IVF-ET）process.the effect of serum estradiol and its daily rising rate on the outcome of assisted pregnancy in patients with recurrent infertility.Methods:The clinical data of ET patients in the Reproductive Medicine Center of our hospital from January 2018 to December 2019 were collected,and the daily increase rate of serum E₂on the day of follicles retrieval and transplantation of each enrolled patient was calculated.After strict screening,infertility patients with elevated E₂levels on the day of follicles retrieval and transplantation were included in a total of 192 study cycles.Grouping according to the range and median of the daily rising rate of E₂:The rising rate of E₂on the day of follicles retrieval is<12%for group A,12%to 24%for group B,and>24%for group C;the rising rate of E₂on day of transplantation is<30%belong to group D,30%～50%belong to group E,and>50%belong to group F.The embryo implantation rate,clinical pregnancy rate and general clinical data were compared between each group on the day of follicles retrieval and the day of transplantation.Results:1.Comparison of the general clinical data of the rising rate of E₂on the day of follicles retrieval,and the comparison of the daily change rate of E₂on the day of follicles retrieval with different levels of endometrial thickness in the tolerance period,the total number of days of Gn medication and the total dose（P<0.05）,age,number of subendometrial perforating vessels in the receptive period,BMI,years of infertility,and b FSH levels were not statistically different（P>0.05）.There were significant statistical differences in embryo implantation rate or clinical pregnancy rate of E₂day rising rate on the follicles retrieval day（P<0.001）.2.There was no significant difference in the E₂day rising rate on the transplantation day with different levels of age,BMI,and infertility years（P>0.05）.There was a statistically significant difference in the number of subendometrial perforating vessels and the thickness of the endometrium at different levels of E₂on the day of transplantation during the tolerance period（P<0.05）.There were significant differences in the rate of increase in E₂day on the day of transplantation between different levels of embryo implantation rate or clinical pregnancy rate（P<0.05）.3.There was no statistical difference in the infertility factors and fertilization methods between the clinical pregnancy success group and the clinical pregnancy failure group（P>0.05）.There were no statistics in the clinical pregnancy success group and clinical pregnancy failure group in age,BMI,number of transplant cycles,b FSH,endometrial thickness,Gn dosage and number of days,E₂daily change rate on the day of follicles retrieval.Difference（P>0.05）.The clinical pregnancy success group and the clinical pregnancy failure group have infertility years,the number of perforator vessels in the endometrium during the receptive period,HCG day,follicles retrieval day,transplantation day E₂level and transplantation day E₂day change rate,there are statistics for comparison between the groups Academic difference（P<0.05）.4.The area under the ROC curve for predicting pregnancy rate of E₂on HCG day,follicles retrieval day,and transplant day are:0.661[95%CI（0.583,0.739）,P<0.05],0.684[95%CI（0.612,0.756）,P<0.05]and 0.715[95%CI（0.645,0.785）,P<0.05],suggesting that E₂levels on HCG day,follicles retrieval day,and transplant day can be used as positive predictors of pregnancy outcome,and E₂levels in the three periods predict pregnancy rate There was no significant difference in the area under the ROC curve between the two groups（P>0.05）.The area under the ROC curve predicted by the E₂daily change rate of the follicles retrieval day and the transplantation day are respectively:0.573[95%CI（0.494,0.653）,P>0.05]and 0.437[95%CI（0.358,0.515）,P>0.05],suggesting that the change rate of E₂on the day of follicles retrieval and the day of transplantation cannot be used as a positive predictor of pregnancy outcome.5.Logistic regression analysis:E₂level on the day of follicles retrieval can be used as an independent predictor to be related to pregnancy rate（P<0.05）.The positive probability of clinical pregnancy in the group with the E₂daily change rate on the follicles retrieval day was 6.695 times that of the group with the low E₂daily change rate on the follicles retrieval day（P<0.001）,and the clinical pregnancy positive probability in the high E₂daily change rate on the follicles retrieval day was The daily change rate of E₂on the follicles retrieval day was 1.357 times that of the low group（P>0.05）.The positive rate of bed pregnancy in the middle group on the day of transplantation E₂was 0.522 times that of the low group（P>0.05）,and the positive rate of bed pregnancy in the high rate of E₂on the day of transplantation was 0.284 times of the positive rate of clinical pregnancy in the low group（P<0.05）.Conclusion:The E₂level on the transplantation day was lower than the serum E₂level on the follicles retrieval day or HCG day,but the rising rate of serum E₂on the transplantation day was higher than the follicles retrieval day.HCG day,follicles retrieval day,transplant E₂level have predictive effect on clinical pregnancy outcome.The E₂level on the day of follicles retrieval can be an independent predictor of pregnancy outcome.During the fresh embryo transfer cycle,too high（>24%）or too low（<12%）rate of increase on OPU day and E₂day suggested a reduced clinical pregnancy outcome.High E₂（>30%）rate on transplantation day may indicate reduced clinical pregnancy outcome.