晚卵泡期孕酮水平对拮抗剂方案妊娠结局的影响

Effect of progesterone level in late-follicular stage on pregnancy outcome in GnRH antagonist protocol cycle

目的探索晚卵泡期孕酮水平对拮抗剂方案的妊娠结局的影响。方法收集2019年1月至2022年11月于武汉大学人民医院生殖医学中心行拮抗剂方案促排卵IVF/ICSI-ET助孕的823例患者资料,根据HCG日血清孕酮水平分为5组:≤0.60 ng/ml(1.91 nmol/L)组、0.61~0.80 ng/ml(1.94~2.54 nmol/L)组、0.81~1.00 ng/ml(2.58~3.18 nmol/L)组、1.01~1.20 ng/ml(3.21~3.82 nmol/L)组和>1.20 ng/ml(3.82 nmol/L)组;再根据促排卵过程中孕酮水平的变化情况将823例研究对象分为3组:A组为晚卵泡期出现孕酮≥1.00 ng/ml,地塞米松治疗后HCG日孕酮>1.20 ng/ml;B组为晚卵泡期出现孕酮≥1.00 ng/ml,地塞米松治疗后HCG日孕酮<1.20 ng/ml;C组为晚卵泡期孕酮水平始终维持在1.00 ng/ml以下。比较各组患者的种植率及临床妊娠率。结果HCG日孕酮>1.20 ng/ml组的胚胎种植率及临床妊娠率显著低于其他各组(P<0.05);当HCG日孕酮>1.20 ng/ml后,孕酮每增加0.1 ng/ml(0.32 nmol/L),胚胎种植率及临床妊娠率均下降约10%;A组胚胎种植率及临床妊娠率均显著低于C组(P<0.05),B组胚胎种植率及临床妊娠率较A组均有增加趋势,但差异无统计学意义(P>0.05),B组与C组间胚胎种植率及临床妊娠率差异无统计学意义(P>0.05)。结论HCG日孕酮>1.20 ng/ml(3.82 nmol/L)显著降低胚胎种植率及临床妊娠率,而晚卵泡期高孕酮水平患者经地塞米松治疗后,胚胎种植率及临床妊娠率均有改善趋势。

Objective:To explore the effect of progesterone level in late-follicular phase on pregnancy outcome in GnRH antagonist protocol cycle.Methods:The clinical data of 823 patients who underwent IVF/ICSI-ET with GnRH antagonist protocol in Reproductive Medicine Center of Renmin Hospital of Wuhan University from January 2019 to November 2022 were collected.The patients were divided into 5 groups according to serum progesterone levels on HCG day:≤0.60 ng/ml(1.91 nmol/L)group,0.61-0.80 ng/ml(1.94-2.54 nmol/L)group,0.81-1.00 ng/ml(2.58-3.18 nmol/L)group,1.01-1.20 ng/ml(3.21-3.82 nmol/L)group and>1.20 ng/ml(3.82 nmol/L)group.They were further divided into the following three groups according to the changes of progesterone level during controlled ovarian stimulation(COS):In group A,the progesterone≥1.00 ng/ml in late-follicular phase,and the progesterone level>1.20 ng/ml after dexamethasone treatment on HCG day;In group B,the progesterone level was≥1.00 ng/ml in late-follicular phase,but the progesterone level was<1.20 ng/ml after dexamethasone treatment;In group C,the progesterone level remained below 1.00 ng/ml in late-follicular phase.The implantation rate and clinical pregnancy rate of each group were compared.Results:The implantation rate and clinical pregnancy rate in the patients with progesterone level on HCG day>1.20 ng/ml group were significantly lower than those in the other groups(P<0.05).When progesterone level on HCG day was>1.20 ng/ml,the implantation rate and clinical pregnancy rate decreased by 10%with every 0.1 ng/ml(0.32 nmol/L)increase in progesterone.The implantation rate and clinical pregnancy rate in group A were significantly lower than those of group C(P<0.05).The implantation rate and clinical pregnancy rate in group B had an increasing trend compared with group A,but the difference was not significant(P>0.05).The implantation rate and clinical pregnancy rate were not significantly different between the group B and group C(P>0.05).Conclusions:When the progesterone level is>1.20 ng/ml(3.82 nmol/L)on HCG day,the implantation rate and clinical pregnancy rate are significantly decreased.After treatment with dexamethasone,the implantation rate and clinical pregnancy rate in the patients with high progesterone levels in the late follicular phase have an improvement trend.