Nawroth Frank, Ludwig Michael
Endokrinologikum Hamburg, Zentrum für Hormon- und Stoffwechselerkrankungen, Reproduktionsmedizin und Gynäkologische Endokrinologie, Germany.
Hum Reprod. 2005 May;20(5):1127-34. doi: 10.1093/humrep/deh762. Epub 2005 Feb 3.
Different studies dealing with the start of progesterone supplementation in assisted reproduction treatment cycles have shown that the problem apparently is the correct timing. We therefore would like to discuss the data on: (i) the start of progesterone replacement in oocyte donation programmes; (ii) the start of progesterone replacement in frozen-thawed hormone-supplemented cycles; (ii) the problem of too early a rise of progesterone in fresh IVF cycles as a model of too early an administration of progesterone; and (iv) the benefit of high progesterone levels on the day of embryo transfer in fresh IVF cycles. From the data reviewed in this paper it seems to be appropriate to start progesterone administration before transfer in oocyte donation programmes as well as transfer of cryopreserved/thawed cells as soon as the endometrium is developed sufficiently (> or =8 mm, trilaminar pattern), and to perform the embryo transfer not before day 3-4 of progesterone treatment, i.e. embryo development on day 2-3. Studies dealing with the influence of too early a rise of progesterone in fresh IVF cycles have shown different results. In fact high progesterone levels seem to reflect a high response but not a lower probability of conception. Furthermore, high progesterone levels on the day of embryo transfer in fresh IVF cycles could lower myometrial contractility and therefore increase implantation rates. Since the experience from oocyte donation programes shows the benefit of a longer preparation time using progesterone, and high progesterone levels seem to have a benefit during embryo transfer, this would suggest extending progesterone administration before transfer. However, we have to find the optimal individual transfer protocol after mock cycles, for example with pinopode detection or other methods applicable in routine IVF programmes. We need more studies to be sure whether reproductive outcome after transfer of cryopreserved-thawed cells in estrogen/progesterone supplement cycles is influenced by the duration of progesterone pretreatment. If this is so, we must look for practicable methods to modify the protocols according to the individual patient, the embryonic developmental stage during transfer and other variables.
不同的关于辅助生殖治疗周期中开始补充孕激素的研究表明,问题显然在于正确的时机。因此,我们想讨论以下方面的数据:(i)卵母细胞捐赠计划中孕激素替代治疗的开始时机;(ii)冻融激素补充周期中孕激素替代治疗的开始时机;(iii)作为过早给予孕激素模型的新鲜体外受精(IVF)周期中孕激素过早升高的问题;以及(iv)新鲜IVF周期中胚胎移植日高孕激素水平的益处。从本文综述的数据来看,在卵母细胞捐赠计划中,以及在子宫内膜充分发育(≥8mm,三层模式)后尽快进行冷冻保存/解冻细胞移植时,在移植前开始给予孕激素似乎是合适的,并且胚胎移植不应早于孕激素治疗的第3 - 4天,即胚胎在第2 - 3天的发育阶段。关于新鲜IVF周期中孕激素过早升高的影响的研究得出了不同的结果。事实上,高孕激素水平似乎反映了高反应性,但并非受孕概率降低。此外,新鲜IVF周期中胚胎移植日的高孕激素水平可能会降低子宫肌层收缩力,从而提高着床率。由于卵母细胞捐赠计划的经验表明使用孕激素进行更长时间准备的益处,并且高孕激素水平在胚胎移植期间似乎有益,这表明应在移植前延长孕激素给药时间。然而,我们必须在模拟周期后找到最佳的个体化移植方案,例如通过检测种植点或其他适用于常规IVF计划的方法。我们需要更多研究来确定在雌激素/孕激素补充周期中冷冻保存/解冻细胞移植后的生殖结局是否受孕激素预处理持续时间的影响。如果是这样,我们必须寻找切实可行的方法,根据个体患者、移植时的胚胎发育阶段和其他变量来调整方案。