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

作　　者：丁锦丽[1] 严思思 杨菁[1] DING Jin-li;YAN Si-si;YANG Jing(Reproductive Medicine Center,Renmin Hospital of Wuhan University,Hubei Clinical Research Center of Assisted Reproduction&Embryonic Development,Wuhan 430060)

机构地区：[1]武汉大学人民医院生殖医学中心,湖北省辅助生殖与胚胎发育医学临床研究中心,武汉430060

出　　处：《生殖医学杂志》2023年第10期1463-1470,共8页Journal of Reproductive Medicine

基　　金：国家自然科学基金青年项目(82101749);湖北省自然科学基金(2021CFB105);中央高校基本科研业务费专项资金(2042021kf0082)。

摘　　要：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 nmo

关 键 词：拮抗剂方案 孕酮 胚胎移植 胚胎种植率 临床妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]