孕激素对促排卵过程中抑制素水平的影响  

Impact of progesterone on inhibins during controlled ovarian stimulation

作　　者：叶静[1] 陈秋菊[1] 何雯[1] 张洁[1] 叶红娟[1] 傅永伦[1] 吕祁峰[1] 匡延平[1] Ye Jing;Chen Qiuju;He Wen;Zhang Jie;Ye Hongjuan;Fu Yonglun;Lyu Qifeng;Kuang Yanping(Department of Assisted Reproduction, Shanghai Ninth People＇s Hospital, Shanghai Jiao Tong University School of A//edicine, Shanghai 200011, China)

机构地区：[1]上海交通大学医学院附属第九人民医院辅助生殖科,200011

出　　处：《中华生殖与避孕杂志》2017年第11期874-882,共9页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金(31071275;81270749;31101070);上海市自然科学基金(11411950105)~~

摘　　要：目的探讨卵巢储备功能正常的妇女在促排卵过程中孕激素对抑制素水平的影响,分析高孕激素状态下促排卵(PPOS)的内分泌特征及随后的冻融胚胎移植(FET)结局。方法 93例接受体外受精/卵胞质内单精子注射(IVF/ICSI)治疗的卵巢储备功能正常者随机分到研究组(PPOS组,n=60)和对照组(短方案组,n=33),测定促排卵过程中(月经周期第3日、第10~12日、诱发排卵日、诱发排卵次日)激素水平、抑制素A和抑制素B表达水平。所有患者采取全部胚胎冷冻的策略,分析后续FET周期的结果。结果在研究组,抑制素A和B的水平随着促排卵过程的继续均呈现增长的趋势,诱发日的抑制素水平[抑制素A为(1 416.4±924.7)pg/m L,抑制素B为(1 188.5±819.1)pg/m L]较基础水平[抑制素A为(29.7±23.4)pg/m L,抑制素B为(82.5±49.4)pg/m L]均有明显增加(P<0.05),诱发排卵次日的抑制素A水平较诱发日明显增加,达到(2 046.7±1 280.5)pg/m L(P<0.05),而诱发排卵次日的抑制素B水平较诱发日略有下降(P>0.05)。获卵数组间无统计学差异,在随后的FET周期中,两组的临床妊娠率、种植率、活产率均无统计学差异(P>0.05)。结论促排卵过程中的高孕激素水平没有影响卵泡周围颗粒细胞分泌抑制素。安宫黄体酮(MPA)联合人绝经期促性腺激素(h MG)进行PPOS可以获得具有发育潜力的胚胎,在随后的FET周期中,可以获得满意的妊娠结局。Objective To explore the impact of progesterone on inhibins during progestin-primed ovarian stimulation （PPOS） in women with normal ovarian reserve and to compare cycle characteristics and pregnancy outcomes in subsequently frozen-thawed embryo transfer （FET） cycles. Methods Totally ＇93 patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET） were randomized to study group （PPOS, n=60） or control group （short protocol~ n=33）. Serum hormones were detected on day 3, day 10-12, the trigger day and the day afLer trigger （approximate l0 h after trigger）. Viable embryos were cryopreserved for later transfer in both protocols. Outcomes of FET were analyzed further. Results In study group inhibins value significantly increased during ovarian stimulation, and average inhibins level [inhibin A （ 1416.4 ± 924.7） pg/mL, inhibin B （ 1 188.5± 819.1） pg/mL] on the trigger day was significantly higher than the basal levels [inhibin A （29.7±23.4） pg/mL, inhibin B （82.5±49.4） pg/mL]（P〈0.05）. Inhibin A value increased significantly to （2 046.7±1 280.5） pg/mL at the day after trigger. Serum inhibin B slightly decreased on the day after trigger later compared with the trigger day, but didn＇t reach any statistical significance. The number of oocytes retrieved in study group was similar to those in the controls. No statistically significant differences were found in the clinical pregnancy rate, implantation rate, and live- birth rate in study group and control group. Conclusion High-level progesterone didn＇t affect the granulosa cells secretion function of inhibins during controlled ovarian stimulation. Medroxyprogesterone acetate （MPA） combined with human menopause gonadotropin （hMG） can obtain competent oocytes/embryos in women undergoing IVF/ICSI treatments, with optimal pregnancy outcomes in FET cycles.

关 键 词：孕激素 抑制素 高孕激素状态下促排卵(PPOS) 

分 类 号：R714.8[医药卫生—妇产科学]