扳机日血清孕酮升高在不同卵巢反应人群中与优胚率的相关性分析

Correlation analysis between serum progesterone elevation and the rate of excellent embryos in different ovarian response populations

目的:探讨在促性腺激素释放激素激动剂(GnRH-a)长方案的体外受精(IVF)周期中,人绒毛膜促性腺激素(hCG)扳机日血清孕酮水平在不同卵巢反应人群中与优胚率的关系。方法:回顾性分析纳入研究的5097例患者,并根据卵巢反应性分成卵巢正常反应组和卵巢高反应组。每组均采用单因素线性回归分析与优胚率有关的参数,选择有统计学意义的因素进一步多因素线性回归分析,计算各参数的相关系数及95%置信区间。将孕酮水平以固定间隔分组,利用非参数检验比较组间优胚率的差异。结果:年龄、体质量指数(BMI)、不孕时间等与优胚率无关(P>0.05),而促性腺激素(Gn)用量、扳机日血清孕酮值和受精率与优胚率相关(P<0.01)。卵巢正常反应组和卵巢高反应组优胚率显著下降时的血清孕酮阈值浓度分别为1.5、1.8ng/mL。结论:hCG扳机日孕酮升高对优胚率有不利影响,且血清孕酮阈值与卵巢反应性有关。

Objective: To explore the association between progesterone levels on the day of human chorionic gonadotrophin(hCG) administration and the rate of excellent embryos in different ovarian responsers in in vitro Fertilization(IVF)cycles with long gonadotropin-releasing hormone agonist(GnRH-a) protocol. Methods: Retrospective analysis was performed on 5 097 patients enrolled in the study who were divided into normal ovarian response group and high ovarian response group based on ovarian reponse. In each group, univariate linear regression analysis was used to analyze the parameters related to excellent embryo rate, and statistically significant factors were selected for further multivariate linear regression analysis to calculate the correlation coefficient and 95% confidence interval for each parameter. The progesterone levels were grouped at regular intervals and the differences in the rate of excellent embryos between the groups were compared using the nonparametric test. Results: Age, body mass index(BMI), infertility time and so on were not related to the rate of excellent embryos (P>0.05), while the amount of gonadotropin (Gn), serum progesterone value on the day of hCG administration and fertilization rate were correlated with the rate of excellent embryos(P<0.01). The serum progesterone threshold concentrations for the intermediate ovarian responder group and the high ovarian responder group were significantly decreased from 1.5 ng/mL and 1.8 ng/mL, respectively. Conclusion: Increased progesterone levels on the day of hCG administration may have a negative effect on the rate of excellent embryos, and serum progesterone threshold concentration may be associated with ovarian responses.