Vandekerckhove Frank, Gerris Jan, Vansteelandt Stijn, De Baerdemaeker An, Tilleman Kelly, De Sutter Petra
Centre for Reproductive Medicine, University Hospital Ghent, De Pintelaan 185, Gent 9000, Belgium.
Reprod Biol Endocrinol. 2014 Apr 23;12:31. doi: 10.1186/1477-7827-12-31.
The negative impact of rising progesterone levels on pregnancy rates is well known, but data on mature oocyte yield are conflicting. We examined whether delaying the oocyte maturation trigger in IVF/ICSI affected the number of mature oocytes and investigated the potential influence of serum progesterone levels in this process.
Between January 31, 2011, and December 31, 2011, 262 consecutive patients were monitored using ultrasound plus hormonal evaluation. Those with > =3 follicles with a mean diameter of > =18 mm were divided into 2 groups depending on their serum progesterone levels. In cases with a progesterone level < = 1 ng/ml, which was observed in 59 patients, 30-50% of their total number of follicles (only counting those larger than 10 mm) were at least 18 mm in diameter. These patients were randomised into 2 groups: in one group, final oocyte maturation was triggered the same day; for the other, maturation was triggered 24 hours later. Seventy-two patients with progesterone levels > 1 ng/ml were randomised in the same manner, irrespective of the percentage of larger follicles (> = 18 mm). The number of metaphase II oocytes was our primary outcome variable. Because some patients were included more than once, correction for duplicate patients was performed.
In the study arm with low progesterone (<= 1 ng/ml), the mean number of metaphase II oocytes (+/-SD) was 10.29 (+/-6.35) in the group with delayed administration of the oocyte maturation trigger versus 7.64 (+/-3.26) in the control group. After adjusting for age, the mean difference was 2.41 (95% CI: 0.22-4.61; p = 0.031). In the study arm with elevated progesterone (>1 ng/ml), the mean numbers of metaphase II oocytes (+/-SD) were 11.81 (+/-9.91) and 12.03 (+/-7.09) for the delayed and control groups, respectively. After adjusting for PCOS (polycystic ovary syndrome) and female pathology, the mean difference was -0.44 (95% CI: -3.65-2.78; p = 0.79).
Delaying oocyte maturation in patients with low progesterone levels yields greater numbers of mature oocytes.
孕酮水平升高对妊娠率的负面影响众所周知，但关于成熟卵母细胞产量的数据却相互矛盾。我们研究了在体外受精/卵胞浆内单精子注射（IVF/ICSI）中延迟卵母细胞成熟触发是否会影响成熟卵母细胞的数量，并调查了血清孕酮水平在此过程中的潜在影响。
在2011年1月31日至2011年12月31日期间，对262例连续患者进行超声检查和激素评估监测。那些有≥3个平均直径≥18mm卵泡的患者根据其血清孕酮水平分为2组。在59例孕酮水平≤1ng/ml的患者中，其卵泡总数（仅计算直径大于10mm的卵泡）的30 - 50%直径至少为18mm。这些患者被随机分为2组：一组在当天触发最终卵母细胞成熟；另一组在24小时后触发成熟。72例孕酮水平>1ng/ml的患者以同样的方式随机分组，而不考虑较大卵泡（≥18mm）的百分比。中期II期卵母细胞的数量是我们的主要结局变量。由于有些患者被多次纳入，因此对重复患者进行了校正。
在孕酮水平低（≤1ng/ml）的研究组中，延迟给予卵母细胞成熟触发剂的组中，中期II期卵母细胞的平均数量（±标准差）为10.29（±6.35），而对照组为7.64（±3.26）。在调整年龄后，平均差异为2.41（95%可信区间：0.22 - 4.61；p = 0.031）。在孕酮水平升高（>1ng/ml）的研究组中，延迟组和对照组中期II期卵母细胞的平均数量（±标准差）分别为11.81（±9.91）和12.03（±7.09）。在调整多囊卵巢综合征（PCOS）和女性病理情况后，平均差异为 - 0.44（95%可信区间： - 3.65 - 2.78；p = 0.79）。
孕酮水平低的患者延迟卵母细胞成熟可产生更多数量的成熟卵母细胞。
