体外受精-胚胎移植拮抗剂周期中人绒毛膜促性腺激素注射日孕酮与雌二醇水平比值对结果的预测价值

The value of progesterone-to-estradiol ratio on the day of hCG administration in predicting pregnancy result of IVF-ET in normo-responders undergoing GnRH antagonist cycles

目的:研究卵巢储备正常的患者在行促性腺激素释放激素拮抗剂方案中,人绒毛膜促性腺激素注射日的孕酮/雌二醇水平比值与临床妊娠率之间的关系。方法:选择2011年至2012年在本中心行促性腺激素释放激素拮抗剂方案促排卵的患者,共164个体外受精/卵胞浆内单精子显微注射-胚胎移植周期,在人绒毛膜促性腺激素注射日应用酶免疫发光法测定其雌二醇及孕酮水平。用受试者工作特征曲线来确定预测临床结果的孕酮/雌二醇比值的临界值,并比较临界值上、下新鲜胚胎移植和冻融胚胎移植2组的临床妊娠率。结果:新鲜胚胎移植组和冻融胚胎移植组的孕酮/雌二醇比值的临界值分别为0.635和0.375,2组中孕酮/雌二醇比值居于临界值上、下患者的临床妊娠率均没有统计学差异;冻融胚胎移植组的整体临床妊娠率高于新鲜胚胎移植组,且孕酮/雌二醇比值越低,冻融胚胎移植方案的优势越明显。结论:对于卵巢储备正常且行促性腺激素释放激素拮抗剂方案促排卵的患者,冻融胚胎移植方案的临床妊娠率优于新鲜胚胎移植方案,且其优势随着孕酮/雌二醇比值的降低更趋明显。

Objective： To investigate the relationship between progesterone-to-estradiol（P/E2） ratio on the day of hCG administration and clinical pregnancy rates in patients with normal ovarian reserve undergoing IVF/ICSI cycles with GnRH antagonist. Methods： One hundred and sixty-four IVF/ICSI cycles with GnRH antagonist protocol in patients with normal ovarian reserve were observed during 2011-2012. P/E2 ratio was detected using chemiluminescence enzyme immunoassay on the day of hCG administration. Receiver operating characteristic （ROC） analysis was performed to determine the optimal cut-off value for the P/E2 ratio related to ET/FET （embryo transplantation/frozen-thawed embryo transplantation） outcomes. The clinical pregnancy rate （CPR） of patients with P/E2 ratio higher than the cut-off value were compared with those with P/E2 ratio lower than the cut-off value. Results： The cutoff values for P/E2 ratio of ET group and FET group were 0.635 and 0.375, respectively. There was no significant difference in clinical pregnancy rate （CPR） between those with higher P/ E2 value and those with lower P/E2 value. The CPR of FET group was higher than that of ET group, and when P/E2 ratio was lower, the advantage of FET was more obvious. Conclusions： For patients with normal ovarian reserve undergoing GnRH antagonist cycles, the CPR in FET group is higher than that in ET group, and the advantage become more apparent when the P/E2 ratio is lower.