体外受精-胚胎移植周期中黄体期血清性激素水平与妊娠率的关系

The Study on the Relationship between Luteal Phase Serum Sex Hormone Levels and Pregnancy Outcome in in Vitro Fertilization Embryo Transfer Cycle

目的探讨体外受精－胚胎移植（ＩＶＦ－ＥＴ）周期中黄体期血清性激素水平的变化及与妊娠率的关系。方法随机选取６２个采用卵泡刺激素／绝经期促性腺激素／绒毛膜促性腺激素（ＦＳＨ／ｈＭＧ／ｈＣＧ）促超排卵的ＩＶＦ－ＥＴ周期（６２例患者），采用放射免疫测定技术，测定其自然周期与促超排卵周期中黄体期血清雌二醇（Ｅ２）、孕酮（Ｐ）、催乳素（ＰＲＬ）水平，观察其妊娠情况。结果促超排卵周期中黄体期血清性激素水平明显高于自然周期（Ｐ＜０．０５）。补充黄体酮者的Ｐ、Ｐ／Ｅ２值，明显高于未补充黄体酮者（Ｐ＜０．０５）。临床妊娠者的Ｅ２水平明显低于未妊娠者，而Ｐ／Ｅ２、ＰＲＬ值明显高于未妊娠者（Ｐ＜０．０５），并且当Ｐ／Ｅ２值为３００～４００、ＰＲＬ值为６０～１００μｇ／Ｌ时妊娠率最高。结论ＩＶＦ－ＥＴ周期中黄体期血清性激素水平对妊娠有影响，其中Ｅ２、Ｐ协同发挥作用，ＰＲＬ在一定范围内有利于胚胎着床。在ＩＶＦ－ＥＴ中应适当补充黄体酮，调节性激素至最适水平。

Objective To study the influence of maternal endocrine factors on clinical pregnancy outcome in an in Vitro Fertilization Embryo Transfer (IVFET) program. Methods 62 IVFET treatment cylces were studied. Luteal phase serum sex hormone levels [estrogen (E2), progesterone (P), prolactin (PRL)] in natural and superovulation cycles were measured by radioimmunoassay and the clinical pregnancy outcome was observed. Results Serum luteal phase sex hormone levels were higher than in natural cycles (P<0.05). P level and P/E2 ratio in progesterone supplementation group were higher than the group without progesterone supplementation (P<0.05). In pregnancy group serum E2 (4 885.5±1 269.0 pmol/L) was lower, PRL (66.4±26.8 μg/L), P/E2 (373.0±152.5) were higher than in nonpregnancy group (E2 6 091.2±1 522.1 pmol/L, PRL 49.1±24.1 μg/L, P/E2 227.4±116.7) (P<0.05). When P/E2 ratio was between 300～400 and PRL level was between 60～100 μg/L, the clinical pregnancy rate increased markedly (P<0.05). Conclusion Luteal phase serum sex hormone level may influence embryo implantation in IVFET. In order to improve the clinical pregnancy rate, it is very necessary to supplement progesterone for the IVFET patients according to the different sex hormone levels.