Department of Reproduction, Instituto Valenciano de Infertilidad, University of Valencia, Plaza de la Policia Local, 3, 46015 Valencia, Spain.
Hum Reprod. 2010 Aug;25(8):2092-100. doi: 10.1093/humrep/deq125. Epub 2010 Jun 10.
The influence of elevated serum progesterone levels during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy rates is a matter of continued debate among fertility clinicians. Efforts to resolve this question have been impeded by the various assays used to measure progesterone and the different, arbitrary threshold values for defining 'high' progesterone levels.
A non-interventional, retrospective, observational, single-centre cohort study evaluated the relationship between serum progesterone levels on the day of human chorionic gonadotrophin (hCG) administration and the ongoing pregnancy rate in 4032 patients undergoing IVF/ICSI cycles using gonadotrophin-releasing hormone (GnRH) analogues for pituitary down-regulation.
Ongoing pregnancy rates were inversely associated with serum progesterone levels on the day of hCG (P < 0.001 for overall trend), irrespective of the GnRH analogue used for pituitary down-regulation. Patients with serum progesterone levels < or = 1.5 ng/ml had significantly higher ongoing pregnancy rates than those with progesterone levels >1.5 ng/ml (31.0 versus 19.1%; P = 0.00006); odds ratio, 0.53 (95% confidence interval, 0.38-0.72). Multivariate regression analysis showed that daily follicle-stimulating hormone dose, number of oocytes and estradiol values on the day of hCG administration were positively associated with progesterone levels (P < 0.0001 for all). Serum progesterone levels were significantly greater in women treated with GnRH agonists (n = 1177) versus antagonists (n = 2855; 0.84 +/- 0.67 versus 0.75 +/- 0.66 ng/ml; P = 0.0003).
Elevated serum progesterone levels on the day of hCG administration is associated with reduced ongoing pregnancy rates. In particular, serum progesterone levels of >1.5 ng/ml were associated with lower ongoing pregnancy rates following IVF/ICSI cycles irrespective of the GnRH analogue used for pituitary down-regulation.
体外受精/卵胞浆内单精子注射（IVF/ICSI）周期中血清孕激素水平升高对妊娠率的影响一直是生育临床医生争论的焦点。由于用于测量孕激素的各种检测方法以及定义“高”孕激素水平的不同、任意阈值值，解决这个问题的努力受到了阻碍。
一项非介入性、回顾性、观察性、单中心队列研究评估了在接受促性腺激素释放激素（GnRH）类似物下调垂体的 4032 名接受 IVF/ICSI 周期的患者中，人绒毛膜促性腺激素（hCG）给药日血清孕激素水平与持续妊娠率之间的关系。
持续妊娠率与 hCG 日血清孕激素水平呈负相关（整体趋势 P<0.001），与用于下调垂体的 GnRH 类似物无关。孕激素水平<或=1.5ng/ml 的患者持续妊娠率显著高于孕激素水平>1.5ng/ml 的患者（31.0%对 19.1%；P=0.00006）；优势比为 0.53（95%置信区间，0.38-0.72）。多变量回归分析显示，hCG 日的每日卵泡刺激素剂量、卵母细胞数和雌二醇值与孕激素水平呈正相关（均 P<0.0001）。接受 GnRH 激动剂（n=1177）治疗的患者的血清孕激素水平显著高于接受 GnRH 拮抗剂（n=2855）治疗的患者（0.84+/-0.67 对 0.75+/-0.66ng/ml；P=0.0003）。
hCG 日血清孕激素水平升高与持续妊娠率降低相关。特别是，无论用于垂体下调的 GnRH 类似物如何，IVF/ICSI 周期后 hCG 日血清孕激素水平>1.5ng/ml 与较低的持续妊娠率相关。
