HCG日血清孕酮值对拮抗剂方案鲜胚移植结局的影响

The effect of serum progesterone levels on HCG trigger day on the outcome of fresh embryo transfer in GnRH antagonist cycles

目的分析HCG日血清孕酮(P)水平对接受拮抗剂方案促排卵的患者鲜胚移植周期结局的影响。方法收集2020年6月至2023年10月在武汉大学人民医院生殖医学中心接受拮抗剂方案促排卵并行鲜胚移植的患者资料,共658个周期。根据HCG日P水平将患者分为4组:A组(P<2.23 nmol/L,n=235)、B组(2.23 nmol/L≤P<3.18 nmol/L,n=246)、C组(3.18 nmol/L≤P<4.13 nmol/L,n=151)及D组(4.13 nmol/L≤P≤6.36 nmol/L,n=26),分析比较4组患者的基本资料、胚胎种植率和临床妊娠率等妊娠结局及相关妊娠并发症。结果4组患者的年龄整体上虽然有显著性差异(P<0.05),但组间两两年龄比较及其余基本资料比较均无显著性差异(P>0.05)。A组患者的胚胎种植率(38.5%)及临床妊娠率(52.3%)最高,且显著高于D组(分别为16.0%和23.1%)(P<0.05),其余组间比较无显著性差异(P>0.05);4组患者间HCG阳性率、早期流产率和异位妊娠率比较也均无显著性差异(P>0.05)。结论拮抗剂方案中,HCG日血清P水平与妊娠结局密切相关。对于卵巢储备功能正常的年轻女性,P<2.23 nmol/L时胚胎种植率和临床妊娠率最优,当P<4.13 nmol/L时均可考虑行鲜胚移植,P≥4.13 nmol/L时则建议全胚冷冻。

Objective:To analyze the effect of serum progesterone(P)levels on HCG trigger day on the outcome of fresh embryo transfer in GnRH antagonist cycles.Methods:Patients who underwent IVF/ICSI cycle with fresh embryo transfer in the Center for Reproductive Medicine,Renmin Hospital of Wuhan University from June 2020 to October 2023 were included in the analysis.A total of 658 cycles of ovulation promotion and fresh embryo transfer were performed using an antagonist protocol.All the included patients were divided into four groups based on serum P levels on HCG trigger day:group A(P<2.23 nmol/L,n=235),group B(2.23 nmol/L≤P<3.18 nmol/L,n=246),group C(3.18 nmol/L≤P<4.13 nmol/L,n=151)and group D(4.13 nmol/L≤P≤6.36 nmol/L,n=26).The basic characteristics,clinical outcomes such as embryo implantation rate,clinical pregnancy rate and related pregnancy complications were compared among the four groups.Results:There were no statistically significant differences in basic characteristics except the age of women among the four groups(P>0.05).The age of women showed an overall difference among the four groups(P<0.05),but there were no significant differences when compared with each other(P>0.05).The embryo implantation rate and the clinical pregnancy rate in group A were the highest(38.5%and 52.3%,respectively),and significantly higher than those of group D(16.0%and 23.1%,respectively,P<0.05),while no significant differences were found among other groups(P>0.05).And HCG positive rate,early miscarriage rate and ectopic pregnancy rate showed no significant differences among the four groups.Conclusions:In the GnRH antagonist regimen,the serum P level on HCG trigger day was closely related to pregnancy outcomes.For young women with normal ovarian reserve who received an antagonist protocol to promote ovulation,when P<2.23 nmol/L,the embryo implantation rate and clinical pregnancy rate were the highest.When P<4.13 nmol/L,fresh embryo transfer could be considered.When P≥4.13 nmol/L,it is recommended trying to freeze the whole embryo.