超排卵中血清孕酮升高

Progesterone elevation occurred in controlled ovarian stimulation

控制性卵巢刺激(COS)中,可以观察到晚卵泡期孕激素升高(PE)的现象。卵泡刺激素(FSH)和黄体生成素(LH)作用于颗粒细胞,促使胆固醇转化为孕酮(P),卵泡膜细胞也能产生足够数量的P。P在卵泡膜细胞内的LH作用下进一步转化为雄激素,孕酮产生的来源过多或者无法及时代谢都会造成循环中的P升高,进而降低子宫内膜容受性,影响体外受精-胚胎移植(IVF-ET)的结局。P水平与成熟卵泡数目、雌激素水平、FSH总剂量正相关,LH过高或过低都促使P升高。与拮抗剂方案相比,降调节超排卵并不增加P升高的几率。选用温和的COS方案、减少FSH剂量、调整外源性FSH/HMG的用药比例、提前HCG诱发排卵时间、全胚冷冻后解冻移植、囊胚移植等方法可以避免P升高导致的不利影响。

Moderate elevations in serum progesterone（P）levels are observed during ovarian stimulation（COS）.FSH and LH act on granulosa cells,promoting cell division and steroid biosynthesis from cholesterol terminating at progesterone biosynthesis.Thecal cells also produce significant amounts of progesterone.Progesterone is further metabolized to androgens by the thecal cells under the trophic influence of LH.Too much source of progesterone and failure metabolism timely causes progesterone elevation（PE）.PE has negative impact on the IVF outcome by reducing endometrial receptivity.The progesterone levels are positively related to number of mature follicles,estradiol levels and total dose of FSH used.Too high and too low LH levels also promote progesterone elevation.Compared with GnRH antagonist protocol,PE does not easily occurred in down-regulation ovarian stimulation with GnRH agonist protocol.Moderate COS protocol,low dose FSH,adjustment proportion of FSH/HMG dosage,earlier administration of HCG,frozen-thawed embryo transfer,blastocyst embryo transfer can avoid negative effect of progesterone elevation.