绒促性素日孕酮水平对体外受精-胚胎移植结局预测价值研究

The Predictive Value of Serum Progesterone Level on HCG-day for In Vitro Fertilization-Embryo Transfer Pregnancy Outcome

目的:探讨促性腺激素释放激素(GnRH)激动剂与拮抗剂方案中注射人绒促性素(HCG)日孕酮(P)对体外受精-胚胎移植(IVF-ET)妊娠结局的预测价值。方法:回顾性分析635例IVF-ET助孕患者的临床资料,采用多因素Logistic回归分析和受试者工作特征曲线(ROC)探讨HCG日P对妊娠结局的预测价值,依据截断值将患者分为两组,比较不同HCG日P水平的临床资料及妊娠情况;并比较采用GnRH激动剂方案和拮抗剂方案的妊娠结局及HCG日P水平。结果:Logistic回归显示HCG日P是影响活产的危险性因素(OR0.612,95%CI 0.480~0.780,P<0.05),其截断值为5.29 nmol/L。HCG日P≥5.29 nmol/L组临床妊娠率(32.70%)与活产率(25.16%)显著低于P<5.29 nmol/L组(56.93%,45.59%),差异有统计学意义(P<0.05)。Gn-RH拮抗剂方案中HCG日P≥5.29 nmol/L的患者比例明显高于激动剂组(35.21%vs 21.50%,P<0.05),而临床妊娠率、活产率及流产率比较,差异无统计学意义(P>0.05)。结论:升高的HCG日P水平降低了IVF-ET的临床妊娠率和活产率,是影响新鲜周期妊娠结局的危险因素,对IVF-ET妊娠结局具有一定的预测价值。GnRH激动剂与拮抗剂两种方案对HCG日P水平的影响程度尚需进一步研究。

Objective:To investigate the predictive value of serum progesterone(P)level on HCG-day in pregnancy outcomes of GnRH agonist and antagonist protocols for in vitro fertilization-embryo transfer(IVF-ET).Meth-ods:The clinical data of 635 patients with IVF-ET were analyzed retrospectively.Logistic regression was applied to analyze the risk factors of pregnancy outcome and receiver operating characteristic(ROC)curve was utilized to explore the predictive value of P level on HCG-day for pregnancy outcome.Patients were divided into two groups according to the cut-off value of P level.Afterwards,the clinical data and pregnancy outcomes of cases with different P level on HCG-day were compared.Meanwhile,the P level on HCG-day and pregnancy outcomes were compared between the GnRH agonist and antagonist protocols.Results:The Logistic regression model demonstrated that P level was a risk factor for live birth(OR 0.612,95%CI 0.480-0.780,P<0.05)with a cutoff value of 5.29 nmol/L.The clinical pregnancy rate(32.70%)and live birth rate(25.16%)of the P≥5.29 nmol/L group were significantly lower when compared with those of the P<5.29 nmol/L group(56.93%,45.59%)(P<0.05).The percentage of patients with P≥5.29 nmol/L in the GnRH antagonist protocols was significantly elevated when compared with that in the GnRH agonist protocols(35.21%vs 21.50%,P<0.05).There was no significant difference in clinical pregnancy rate,live birth rate and abortion rate.Conclusions:Elevated P level could decrease the clinical pregnancy rate and live birth rate of IVF-ET.P level on HCG-day may be a risk factor for the outcome of fresh cycle pregnancy and a promising candidate for prediction of pregnancy outcome of IVF-ET.The effect of GnRH agonist and antagonist on HCG day P needs further study.