hCG日孕酮水平对拮抗剂方案卵裂期胚胎移植后临床结局的影响  

Impact of progesterone concentration on hCG trigger day on clinical outcomes with cleavage-stage embryo transfer in in vitro fertilization cycles with an antagonist protocol

作　　者：贾楠 郝好英 宋冰冰 李萌 张翠莲 张少娣 Jia Nan;Hao Haoying;Song Bingbing;Li Meng;Zhang Cuilian;Zhang Shaodi(Reproductive Medicine Center,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,ZhengZhou 450003,China)

机构地区：[1]郑州大学人民医院,河南省人民医院生殖医学中心,郑州450003

出　　处：《中华妇产科杂志》2024年第10期777-785,共9页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨拮抗剂方案促排卵患者, 人绒毛膜促性腺激素(hCG)日孕酮水平对新鲜周期和全胚冷冻解冻周期卵裂期双胚胎(至少1个为优质)移植后临床结局的影响。方法回顾性分析2017年1月至2023年12月在河南省人民医院生殖医学中心行拮抗剂方案促排卵辅助生殖治疗患者的临床资料, 纳入第1~2次取卵新鲜周期及全胚冷冻后解冻周期(共2 165个周期), hCG日血清孕酮水平均≤6.34 nmol/L(即2 ng/ml)。根据hCG日孕酮水平, 采用多元logistic回归、拟合曲线等统计学方法比较临床妊娠率、活产率等结局指标。结果以周期类型即新鲜周期或解冻周期为暴露变量进行多元logistic回归分析, 在hCG日孕酮水平≤3.17 nmol/L(即1 ng/ml)及1~2 ng/ml的患者中, 无论孕酮水平≤1 ng/ml或是1~2 ng/ml, 新鲜周期和解冻周期的临床妊娠率(≤1 ng/ml:OR=0.93, 95%CI为0.75~1.14;1~2 ng/ml:OR=1.05, 95%CI为0.58~1.87)、活产率(≤1 ng/ml:OR=0.90, 95%CI为0.71~1.13;1~2 ng/ml:OR=1.53, 95%CI为0.79~3.00)均无明显差异(P均>0.05)。以hCG日孕酮水平作为连续变量绘制拟合曲线, 新鲜周期或解冻周期的临床妊娠率并不会随着孕酮水平的升高而发生明显变化。结论拮抗剂方案中hCG日血清孕酮水平≤2 ng/ml时, 患者新鲜周期和解冻周期行卵裂期双胚胎(至少1个为优质)移植的临床妊娠率和活产率无明显差异, 临床上可根据患者实际情况选择移植或冷冻策略。Objective:To investigate the impact of the progesterone concentration on human chorionic gonadotropin(hCG)trigger day in fresh cycles versus thawed transfer cycles(the freeze-all strategy)with an antagonist protocol,and to compare the differences in clinical outcomes.Methods:This retrospective cohort study included a total of 2165 cycles conducted at Henan Provincial People′s Hospital with cleavage-stage embryo(at least one top-quality)transfer between January 2017 and December 2023,with serum progesterone levels on hCG trigger day all≤6.34 nmol/L(i.e.2 ng/ml).Multivariate logsitic regression analysis and curve fitting were performed based on different serum progesterone levels on hCG trigger day[≤3.17 nmol/L(i.e.1 ng/ml)or 1-2 ng/ml].Results:Multivariate regression analysis,by using cycle type(either fresh or frozen-thawed cycle)as the exposure variable,showed that the clinical pregnancy rate(≤1 ng/ml:OR=0.93,95%CI:0.75-1.14;1-2 ng/ml:OR=1.05,95%CI:0.58-1.87)and live birth rate(≤1 ng/ml:OR=0.90,95%CI:0.71-1.13;1-2 ng/ml:OR=1.53,95%CI:0.79-3.00)had no statistically significant differences in group of progesterone concentration≤1 ng/ml or in group of 1-2 ng/ml.Using serum progesterone levels on hCG trigger day as a continuous variable for curve fitting analysis,the clinical pregnancy rate in fresh or thawed cycles showed no significant changes with increasing progesterone levels.Conclusions:In the antagonist protocol with cleavage-stage embryo transfer(at least one top-quality),when the serum progesterone level on hCG day is≤2 ng/ml,there are no significant differences in clinical outcomes between thawed cycles and fresh cycles,including clinical pregnancy rate and live birth rate.Transferred in fresh cycles or choosing the freeze-all strategy could be selected based on the actual situation of the patients.

关 键 词：绒毛膜促性腺激素 孕酮 排卵诱导 分裂期 卵 胚胎移植 妊娠率 激素拮抗药 

分 类 号：R714.8[医药卫生—妇产科学]