血清孕酮升高对卵巢不同反应者体外受精-胚胎移植结局的影响

Effect of serum progesterone level on the outcome of IVF in patients with different ovarian response:an analysis of over 10,000 cycles

目的探讨卵巢不同反应者人绒膜促性腺激素(HCG)日血清孕酮水平与体外受精(IVF)结局之间的关系。方法回顾分析2002年1月至2011年9月11,055例IVF采卵周期和4,021例复苏周期,根据获卵数将卵巢反应性依次分为:卵巢高反应组(获卵数≥20;2,023例)、卵巢低反应组(获卵数≤4;827例)和中间反应组(5≤获卵数<20;8,205例)。根据HCG日血孕酮水平分别比较不同卵巢反应组的新鲜周期和复苏周期的妊娠率、胚胎着床率及各临床指标的差异。采用多元回归分析探讨影响孕酮升高的临床因素,采用趋势分析评定各组血清孕酮的切点值。结果随着血清孕酮水平的升高,不同反应组其新鲜周期的胚胎着床率和妊娠率均明显下降(P<0.05)。但受精率、卵裂率和复苏周期的妊娠率无明显差异(P>0.05)。卵巢不同反应者其孕酮升高影响妊娠率的切点值不同:低、中和高反应者孕酮切点值依次为1.5、1.75和2.25 ng/ml。结论不论卵巢反应性如何,孕酮升高均影响新鲜周期的妊娠率。但随着卵巢反应性的增加,孕酮切点值也随之升高。孕酮升高不影响复苏周期的妊娠率,故可能并不是通过影响卵母细胞质量而负面影响新鲜周期妊娠率。

Objective. To investigate the relationship between the serum progesterone （P） levels on the day of HCG administration and pregnancy outcomes in different responders undergoing in vitro fertilization （IVF）. Methods. A total of 11,055 women who underwent their first IVF/ICSI cycles, and a subgroup of 4,021 women undergoing frozen embryo transfer （FET） cycles. The patients underwent IVF-ET with the long GnRH agonist protocol. The ovarian response was classified as high （≥20 oocytes;n= 2,023）,poor （44 oocytes;n=827）,or intermediate （remaining cases;n=8,205） according to the number of oocytes retrieved. Clinical outcomes of IVF-ET and FET cycles were analyzed according to serum P levels. Results. Ongoing pregnancy rate in fresh cycle was inversely associated with serum P levels on the day of HCG administration for all patients. The serum P levels of 1.5,1.75 and 2.25 ng/ml could be served as the threshold for poor, intermediate and high responders respectively. Our study did not show negative effect of elevated P levels on oocyte performance in terms of fertilization, cleavage rate, or pregnancy rate in FET cycles among the different ovarian responses, offering no evidence for a detrimental effect of high P on oocyte quality. Conclusions： Elevated P levels on the day of HCG administration negatively influence pregnancy rate regardless of different ovarian responses, while increased P cutoff value is associated with better ovarian responses. The detrimental effect of P elevation on pregnancy rate is unrelated to oocyte quality in all responders.