女性晚卵泡期孕酮升高对胚胎移植时E2水平及内膜容受性影响

The impact of late follicular phase progesterone on ET days E2 levels and endometrial receptivity

目的:探讨控制性超促排卵(COH)周期胚胎移植日雌激素与体外受精-胚胎移植(IVF-ET)结局的关系。方法:104例不育症患者行COH,在人绒毛膜促性腺激素(HCG)注射日检测血清雌孕激素及ET日雌激素水平,依孕激素P值水平分为四组:P≤0.9 ng/mL,0.9ng/mL<P≤1.1ng/mL,1.1ng/mL<P≤1.4ng/m,P>1.4ng/mL,对比组间雌激素水平、胚胎发育及妊娠结局差异。结果:1)高龄患者促排卵用促性腺激素GN剂量增多,HCG日E2和新鲜胚胎移植日E2值在35周岁以上组中显著下降,获卵数和成熟卵数及可移植胚胎的数目随年龄增加显著降低。2)妊娠组移植优胚数目明显高于未妊娠组,且胚胎移植日E2值增高及晚卵泡期P/MⅡ值降低,但结果未见显著差异。3)HCG日血清孕激素水平升高引起移植日E2升高及胚胎种植率下降,但未见显著差异。结论:低雌激素水平可使子宫种植床延长,P升高组患者雌孕激素分泌不协调,晚卵泡期P升高降低妊娠率,每成熟卵泡孕激素水平对助孕结局预测有待进一步探讨。

Objective:To investigate the relationship of ET days estrogen level and in vitro fertilization-embryo transfer(IVF-ET)outcome in controlled ovarian hyperstimulation(COH)cycle.Methods:Detect human chorionic gonadotropin(HCG)injection day serum estrogen and progesterone and estrogen levels on ET days,then according to progesterone values,104 cases of infertility patients were divided into four groups:P≤0.9ng/mL,0.9ng/mL<P≤1.1ng/mL,1.1ng/mL<P≤1.4ng/m,P>1.4ng/mL,compared the differences in estrogen levels and embryonic development as well as pregnancy outcome.Results:1)Elderly patient ovulation induction with gonadotropins increased dose,the E2 levels were significantly decreased on fresh embryo transfer day and HCG day over 35 years of age,the number of obtaind and mature oocytes reduced significantly with increased age,also with the D3 can be transferred embryos.2)The number of excellent embryos transplanted was significantly higher in pregnancy group than the non-pregnant group,day of embryo transfer the E2 values was higher and late follicular phase P/MⅡvalue was lower in pregnancy group,but showed no significant differences.3)The rise of serum progesterone levels on HCG day can cause E2 increase on embryo transplant day,but embryo implantation rate has dropped,with no significant difference.Conclusion:Low estrogen levels can prolong the uterus embryo implantation window,P elevated cause uncoordinated secretion on estrogen and progesterone,P increased on late follicular phase can decrease pregnancy rate,per mature follicle progesterone levels prediction on IVF outcome needs further explored.