促性腺激素释放激素拮抗剂方案HCG日血清孕酮水平升高的影响因素分析

Analysis of influencing factors of serum progesterone elevation on HCG day in GnRH antagonist protocol

目的分析应用促性腺激素释放激素拮抗剂(GnRH-ant)方案促排卵时HCG日血清孕酮(P)水平升高的发生情况及其影响因素。方法回顾性分析2018年10月至2021年10月在我院生殖医学科采用拮抗剂方案促排卵的391个IVF/ICSI-ET周期的临床资料,按照本周期HCG日血清P水平不同分为两组:正常水平组(HCG日P水平<4.77 nmoL/L,306个周期)和高水平组(HCG日P水平≥4.77 nmoL/L,85个周期)。比较两组患者的基本情况和促排卵实验室参数,并采用多因素Logistic回归模型分析HCG日P水平的影响因素。结果本研究中,HCG日P水平≥4.77 nmoL/L的发生率为21.7%(85/391)。两组患者的年龄、不孕年限、基础FSH(bFSH)、基础LH(bLH)、基础E_(2)(bE_(2))及抗苗勒管激素(AMH)水平均无显著性差异(P>0.05);与正常水平组比较,高水平组的体质量指数(BMI)显著降低,基础孕酮(bP)水平显著升高(P<0.05)。两组患者的Gn启动剂量、Gn总剂量、Gn天数及HCG日LH水平均无显著性差异(P>0.05);高水平组的HCG日E_(2)和P水平均显著高于正常水平组(P<0.05)。多因素Logistic回归分析结果显示,BMI≥24 kg/m^(2)患者HCG日P水平升高的风险较BMI<24 kg/m^(2)的患者显著降低(OR=0.446,P<0.05);bP≥1.91 nmoL/L患者HCG日P水平升高的风险较bP<1.91 nmoL/L的患者显著升高(OR=1.961,P<0.05);HCG日E_(2)≥11010 pmoL/L患者HCG日P水平升高的风险较HCG日E_(2)<11010 pmoL/L的患者显著升高(OR=3.303,P<0.05)。结论BMI<24 kg/m^(2)、bP和HCG日E_(2)水平较高是HCG日P水平升高的独立危险因素。促排卵中晚期应综合权衡基础BMI、bP、HCG日E_(2)水平调整Gn用量,降低HCG日P水平升高的风险。

Objective:To investigate the influencing factors of serum progesterone(P)elevation on HCG day in GnRH antagonist(GnRH-ant)protocol.Methods:The clinical data of 391 IVF/ICSI-ET cycles with GnRH-ant protocol conducted in the reproductive center of our hospital from October 2018 to October 2021 were retrospectively analyzed.The cycles were divided into two groups according to the serum P level on HCG day:normal level group with serum P level<4.77 nmol/L(n=306)and high level group with serum P level≥4.77 nmol/L(n=85).The general data of patients and ovulation induction laboratory parameters in two groups were compared,and multivariate logistic regression model was used to analyze the influencing factors of P elevation on HCG day.Results:The incidence of serum P≥4.77 nmoL/L on HCG day was 21.7%in the study.There were no significant differences in age,years of infertility,basal FSH,basal LH,basal E_(2) and AMH levels between the two groups(P>0.05).Compared with the normal level group,the body mass index(BMI)of the high level group decreased significantly,and the basal progesterone level increased significantly(P<0.05).There were no significant differences in the initial dose of gonadotropin(Gn),the total dose of Gn,the Gn days and the level of LH on HCG day between the two groups(P>0.05).E_(2) and P levels on HCG day in high level group were significantly higher than those in normal level group(P<0.05).Logistic regression results showed that patients with BMI≥24 kg/m^(2) had a significantly lower risk of P elevation on HCG day than those with BMI<24 kg/m^(2)(OR=0.446,P<0.05).Patients with basal P≥1.91 nmol/L had a significantly higher risk of P elevation on HCG day than patients with basal P<1.91 nmol/L(OR=1.961,P<0.05).The risk of P elevation on HCG day in patients with E_(2)≥11010 pmol/L on HCG day was significantly higher than that in patients with E_(2)<11010 pmol/L on HCG day(OR=3.303,P<0.05).Conclusions:BMI<24 kg/m^(2),basal P and serum E_(2) level on HCG day were independent risk factors for serum P elevation on HCG day.In the middle and late phases of ovulation induction,the basal BMI,basal P and E_(2) levels on HCG day should be comprehensively weighed to adjust the dosage of gonadotropin,so as to reduce the risk of increasing P levels on HCG day.