人绒毛膜促性腺激素注射日血清孕酮水平升高预测体外受精-胚胎移植妊娠率降低

目的探讨控制性卵巢刺激(COS)过程中不同时间点血清孕酮(P)水平对体外受精-胚胎移植(IVF-ET)治疗结局的预测价值以及血清P水平影响IVF-ET妊娠率的机制。方法选择采用促性腺激素释放激素激动剂(GnRH-a)长方案治疗的175例患者进行回顾性研究。检测COS前1d、COS第4天、第6~7天和人绒毛膜促性腺激素(HCG)日4个时间点的血清P值,应用"受试者工作特性曲线"(ROC曲线)分析血清P值对助孕治疗结局的预测价值,根据ROC曲线设定一个血清P的临界值,观察≥临界值组和临界值组的各项临床指标,分析血清P水平通过何种途径影响助孕治疗的结局。结果COS前1d、COS第4天、第6~7天和HCG注射日4个时间点P值的ROC曲线下面积分别为0.537(P=0.398)、0.540(P=0.363)、0.629(P=0.025)、0.635(P=0.002)。HCG日P=7.925nmol/L时,预测助孕治疗结局的灵敏度是40.0%,特异度是78.8%。P≥7.925nmol/L组子宫内膜厚度小于P7.925nmol/L组(P0.05),两组间受精率、卵裂率、优胚率均无显著差异(P0.05)。结论 HCG注射日P水平升高(P≥7.925nmol/L)导致IVF-ET妊娠率下降。HCG日P水平升高对卵母细胞质量、胚胎质量没有影响,可能通过影响子宫内膜的容受性而影响助孕治疗结局。

Elevated serum progesterone level on HCG-day predicts pregnancy rates fall in IVF-ET

Objective： To explore predictive value of serum progesterone（P）levels at different time points in controlled ovarian hyperstimulation（COS）for outcome of in vitro fertilization-embryo transfer（IVF-ET）. Methods： The serum P levels of 175 patients with long agonist protocol were measured at four time points,i, e. the day before COS, the 4th day of COS, the 6th-7th day of COS and HCG-day. Receiver operating characteristic（ROC）curve was used to assess the predictive value of P levels for pregnancy rate. The threshold of P level was selected based on ROC curve. Then the patients were grouped according to P levels≥threshold or〈threshold. The clinical indicators were compared between the two groups. Results： The area 0.363）,0.629（P=0. selected as a thresho 0 d under the curve（AUC）at the four time points was 0. 537（P=0. 398）,0. 540（P= 25）and 0. 635（P=0. 002） ,respectively. The P level of 2.5 ng/ml on HCG day was There were no significant differences in fertilization rate, cleavage rate,and highquality embryo rates between the two groups. Conclusions. In conclusion, elevation of serum P level （P ≥ 7. 925nmol/1） on HCG-day is associated with reduced pregnancy rates in IVF-ET. The elevation of P levels on HCG-day has no influence on oocyte quality and embryo quality.