控制性促排卵中过早血清孕酮升高的原因

Causes of premature serum progesterone elevation in controlled ovarian stimulation

控制性促排卵（COS）中过早血清孕酮升高（PE）是指HCG注射前血清孕酮过早的轻度升高,PE并非颗粒细胞过早黄素化所致.虽然PE的原因和机制目前尚未完全阐明,但过多成熟卵泡/卵母细胞数、大剂量卵泡刺激素（FSH）促排卵、高雌二醇（E2）水平及促黄体生成素（LH）相对不足与PE呈明显相关.大量研究已发现PE明显降低COS鲜胚移植周期的妊娠率,其原因可能是PE负面影响了子宫内膜接受性.目前对PE阈值并无统一标准,通常以HCG注射前或HCG注射日血清孕酮的绝对值作为界定标准.最近Venetis CA等荟萃分析超过60 000个IVF周期结果显示,血清孕酮过早升高至0.8～1.1 ng/ml（2.54～3.50 nmol/L）即表现为鲜胚移植周期的妊娠率明显降低,且随着血清孕酮水平升高妊娠率下降,但当过早升高的孕酮≥1.2 ng/ml（3.82 nmol/L）,妊娠率则稳定在低水平并未随血清孕酮水平的进一步上升而下降.

The premature serum progesterone （P）elevation （PE）in controlled ovarian stimulation （COS）is usually defined as subtle premature increase in serum P concentrations on or before the day of HCG administration. PE is not due to premature luteinizing granulosa cells induced by premature LH surge. Although the causes and mechanisms of PE are not yet fully elucidated, the high FSH dose, numerous numbers of follicles/oocytes, high E2 level, and inadequate LH bioactivity are associated with PE. Many studies showed that PE on the day of HCG administration is associated with a significantly decreased probability of pregnancy after fresh embryo transfer in women undergoing ovarian stimulation by using gonadotrophin and GnRH analogue for IVF. The detrimental effect of PE on pregnancy rates is hypothesized to be exerted through its action on the endometrium. There is no uniform standard threshold for PE. A latest meta-analysis of over 60 000 cycles showed that the detrimental effect of PE on the probability of pregnancy in fresh IVF cycles seems to be present when P levels increase to the range of 0.8- 1.1 ng/ml（2. 54-3. 50 nmol/L）. The pregnancy rate decreases along with progesterone concentration until 1.2 ng/ml（3.82 nmol/L）. Interestingly,this detrimental effect appears relatively stable after 1.2 ng/ml.