Manno Massimo, Tomei Francesco
DSS of Pathophysiology of Human Reproduction, Sperm and Oocyte Bank, Maternal Pediatric Department, Pordenone Hospital, via Montereale 24, 33170 Pordenone, Italy.
DSS of Pathophysiology of Human Reproduction, Sperm and Oocyte Bank, Maternal Pediatric Department, Pordenone Hospital, via Montereale 24, 33170 Pordenone, Italy.
Med Hypotheses. 2014 Jan;82(1):122-3. doi: 10.1016/j.mehy.2013.11.004. Epub 2013 Nov 14.
From 1991 there is a long-lasting discussion on a possible detrimental effect of premature increase of progesterone levels during ovarian stimulation in IVF. A recent meta-analysis of more than 60,000 cycles states that premature progesterone increase reduces pregnancy rates starting from P4 values of 0.8 ng/ml. The detrimental effect seems to be related to endometrial receptivity impairment according to lack of detrimental effect on oocytes competence in ovodonation. Embryo freezing and deferred embryo transfer on artificial endometrium permits to avoid this detrimental effect but the cycle has to be segmented in two phases. Moreover embryo freezing is an extra burden for IVF lab and could induce embryo damage. So the implementation of an effective pharmacological treatment to prevent premature luteinization could be very interesting for our daily ART practice. On the basis of so far available literature data and our preliminary proof of concept experience we suggest that metformin (1000-1500 mg daily) from first monitoring until ovulation triggering could be suitable for this purpose irrespective of ovarian reserve of the patient.
自1991年以来，关于体外受精（IVF）卵巢刺激过程中孕酮水平过早升高可能产生的有害影响一直存在长期讨论。最近一项对60000多个周期的荟萃分析表明，从孕酮（P4）值达到0.8 ng/ml开始，孕酮过早升高会降低妊娠率。根据对卵子捐赠中卵母细胞能力没有有害影响这一点来看，这种有害影响似乎与子宫内膜容受性受损有关。胚胎冷冻和在人工子宫内膜上进行胚胎移植延期可以避免这种有害影响，但周期必须分为两个阶段。此外，胚胎冷冻对IVF实验室来说是一项额外负担，并且可能导致胚胎损伤。因此，实施有效的药物治疗以预防过早黄素化对于我们日常的辅助生殖技术（ART）实践可能非常有意义。基于目前可得的文献数据以及我们初步的概念验证经验，我们建议，无论患者的卵巢储备情况如何，从首次监测到触发排卵期间每日服用二甲双胍（1000 - 1500 mg）可能适用于此目的。
