扳机日孕酮升高与获卵数对辅助生殖技术新鲜周期妊娠结局的影响

目的 探讨人绒毛膜促性腺激素(hCG)日孕酮升高对辅助生殖技术(ART)新鲜周期妊娠结局的影响及与获卵数的关系。 方法 回顾性分析2019年1月至2020年12月于河北医科大学第二医院生殖医学科接受体外受精-胚胎移植(IVF-ET)或卵细胞质内单精子注射(ICSI)新鲜周期移植D3胚胎的不孕患者,共纳入2 437例患者。通过单因素分析、多元Logistic回归分析、平滑曲线拟合及阈值效应分析hCG日孕酮升高对ART新鲜周期妊娠结局的影响,并通过分层分析评估其影响是否与获卵数有关。 结果 所有患者调整混杂因素后,阈值效应分析结果显示,hCG日孕酮≥1.5 ng/mL时,孕酮每增加1 ng/mL,临床妊娠率下降60%(95%CI:0.2~0.7,P=0.004),宫内妊娠率下降70%(95%CI:0.2~0.7,P=0.003),活产率下降70%(95%CI:0.1~0.7,P=0.004)。按获卵数分组后结果显示,获卵数5~10时,hCG日孕酮≥1.8 ng/mL时,孕酮每增加1 ng/mL,临床妊娠率下降100%(95%CI:0.0~0.1,P=0.002);宫内妊娠率下降100%(95%CI:0.0~0.0,P<0.001);hCG日孕酮≥1.6 ng/mL时,孕酮每增加1 ng/mL,活产率下降90%(95%CI:0.0~1.0,P=0.049)。获卵数10~15时,孕酮≥1.1 ng/mL时,孕酮每增加1 ng/mL,临床妊娠率下降70%(95%CI:0.1~0.7,P=0.006),宫内妊娠率下降70%(95%CI:0.1~0.6,P=0.003),活产率下降70%(95%CI:0.1~0.6,P=0.003)。 结论 在接受IVF/ICSI新鲜周期移植的不孕患者中,hCG日孕酮≥1.5 ng/mL是影响临床妊娠率、宫内妊娠率和活产率的独立危险因素。分组后孕酮升高对获卵数5~15的患者影响更为明显,因此,若hCG日孕酮升高且获卵数在5~15之间的患者可行全胚冷冻,以期改善妊娠结局。

Relationship between the number of retrieved oocytes and IVF outcomes correlated with elevated progesterone on hCG day

Objective To investigate the effects of progesterone elevation on the day of human chorionic gonadotropin(hCG)administration on in vitro fertilization(IVF)pregnancy outcomes, and to explore the relationship between the number of retrieved oocytes and IVF outcomes correlated with elevated progesterone. Methods A total of 2,437 patients who underwent IVF/intracytoplasmic sperm injection(ICSI)treatment cycles during Jan. 2019 and Dec. 2020 were retrospectively enrolled. The effects of progesterone elevation on IVF pregnancy outcomes were determined with univariate regression analysis, multivariate Logistic regression analysis, smoothed curve fitting and threshold effects, and whether the effects were related to the number of retrieved oocytes was assessed with stratified analysis. Results After confounding factors were adjusted, analysis of threshold effects showed when the progesterone level was ≥1.5 ng/mL on hCG day, with a 1 ng/mL increase in the progesterone level, the clinical pregnancy rate decreased by 60%(95%CI: 0.2-0.7, P=0.004), the intrauterine pregnancy rate decreased by 70%(95%CI: 0.2-0.7, P=0.003), and the live birth rate decreased by 70%(95%CI: 0.1-0.7, P=0.004). After grouping according to the number of retrieved oocytes, when the number of retrieved oocytes was 5-10 and the progesterone level was ≥1.8 ng/mL on hCG day, with a 1 ng/mL increase in the progesterone level, the clinical pregnancy rate decreased by 100%(95%CI: 0.0-0.1, P=0.002), and the intrauterine pregnancy rate decreased by 100%(95%CI: 0.0-0.010, P<0.001). When the progesterone level was ≥1.6 ng/mL on hCG day, with a 1 ng/mL increase in the progesterone level, the live birth rate decreased by 90%(95%CI: 0.0-1.0, P=0.049). When the number of retrieved oocytes was 10-15 and the progesterone level was ≥1.1 ng/mL on hCG day, with a 1 ng/mL increase in the progesterone level, the clinical pregnancy rate decreased by 70%(95%CI: 0.1-0.7, P=0.006), the intrauterine pregnancy rate decreased by 70%(95%CI: 0.1-0.6, P=0.003), and the live birth rate decreased by 70%(95%CI: 0.1-0.6, P=0.003). Conclusion Elevated progesterone level on hCG day is an independent risk factor affecting the IVF pregnancy outcomes. There is a remarkable effect on patients with the number of oocytes 5-15 with elevated progesterone. So the pregnancy outcomes of normal ovarian response patients can be improved by freezing all embryos when the progesterone level is more than 1.5 ng/mL.