在接受首次体外受精周期治疗的高反应患者中，人绒毛膜促性腺激素（hCG）日雌二醇水平升高对活产率没有影响。
In high responding patients undergoing an initial IVF cycle, elevated estradiol on the day of hCG has no effect on live birth rate.
作者信息
Zavy Michael T, Craig LaTasha B, Wild Robert A, Kahn Sana N, O'Leary Dena, Hansen Karl R
机构信息
Section of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA.
出版信息
Reprod Biol Endocrinol. 2014 Nov 28;12:119. doi: 10.1186/1477-7827-12-119.
BACKGROUND
The impact of elevated estradiol on the day of human chorionic gonadotropin (hCG) administration on in vitro fertilization (IVF) outcomes has been debated for over 25 years. Some investigators have shown a positive effect, others a negative effect; while most have shown no effect. Few studies have expressed their findings based on live birth. This study examined the relationship between estradiol level and other IVF cycle response parameters in relation to pregnancy, with a focus on live births after controlling for embryo quality.
METHODS
We performed a retrospective cohort study on 489 patients <40 years old that underwent an initial IVF cycle. Estradiol concentration on the day of hCG was categorized as; low <2000 pg/ml), mid (2001-4000 pg/ml) and high (>4000 pg/ml) to determine how estradiol level on the day of hCG affected response variables during the IVF cycle. We performed a subgroup analysis restricted to patients with good/fair quality embryos transferred (n=428), to control for embryo quality and assessed pregnancy outcome. The association between estradiol and live birth (LB) was then evaluated after identifying and controlling for confounding factors. Multivariate analysis was used to identify significant main effects and interactions in the model. Estradiol levels were also compared in patients having a LB or not (NLB) in both populations.
RESULTS
We found that estradiol was significantly related to + hCG, clinical pregnancy rate, age, and most other IVF cycle response variables. After performing the subgroup analysis controlling for embryo quality, we found that LB rates were not different. Only the main effects of average embryo quality at transfer (AEQS), age and transferring two embryos influenced LB. Estradiol levels were also compared in patients having a LB or NLB in both populations and was found to be higher/not different in LB patients. LB rates and AEQS were also not different in a subgroup of patients having an elevated level of estradiol (>4200 pg/ml) on the day of hCG in patients having embryo transfer on day 3 or day 5.
CONCLUSIONS
After controlling for embryo quality, elevated estradiol on the day of hCG had no effect on LB.
背景
人绒毛膜促性腺激素（hCG）给药当天雌二醇水平升高对体外受精（IVF）结局的影响已争论了25年多。一些研究者显示出积极影响，另一些则显示出消极影响；而大多数研究显示无影响。很少有研究基于活产来阐述其研究结果。本研究在控制胚胎质量的基础上，探讨了雌二醇水平与其他IVF周期反应参数与妊娠的关系，重点是活产情况。
方法
我们对489例年龄小于40岁且首次接受IVF周期治疗的患者进行了一项回顾性队列研究。将hCG给药当天的雌二醇浓度分为低（<2000 pg/ml）、中（2001 - 4000 pg/ml）和高（>4000 pg/ml）三个类别，以确定hCG给药当天的雌二醇水平如何影响IVF周期中的反应变量。我们对移植了优质/中等质量胚胎的患者（n = 428）进行了亚组分析，以控制胚胎质量并评估妊娠结局。在识别并控制混杂因素后，评估雌二醇与活产（LB）之间的关联。采用多变量分析来确定模型中的显著主效应和交互作用。还比较了两组中有活产或无活产（NLB）患者的雌二醇水平。
结果
我们发现雌二醇与 + hCG、临床妊娠率、年龄以及大多数其他IVF周期反应变量显著相关。在进行了控制胚胎质量的亚组分析后，我们发现活产率没有差异。只有移植时的平均胚胎质量（AEQS）、年龄以及移植两个胚胎的主效应影响活产。还比较了两组中有活产或无活产患者的雌二醇水平，发现活产患者的雌二醇水平更高/无差异。在第3天或第5天进行胚胎移植的患者中，hCG给药当天雌二醇水平升高（>4200 pg/ml）的亚组患者的活产率和AEQS也没有差异。
结论
在控制胚胎质量后，hCG给药当天雌二醇水平升高对活产没有影响。
Zotero 插件