Saharkhiz Nasrin, Salehpour Saghar, Tavasoli Mahboobeh, Aghighi Ali
Infertility and Reproductive Health Research Center (IRHRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Baqiyatallah University of Medical Sciences, Tehran, Iran.
Iran J Reprod Med. 2015 Feb;13(2):79-84.
Premature luteinization during in vitro fertilization was commonly happened before the introduction of GnRh analogues. High level of unwanted progesterone is associated with adverse pregnancy outcome and is thought to be induced by inappropriate LH elevation.
To evaluate the progesterone level on the day of Human Chorionic Gonadotropin (HCG) triggering in GnRh agonist and antagonist protocols, and its correlation with clinical pregnancy rate and miscarriage rate.
One hundred and seven women underwent intracytoplasmic sperm injection with long agonist protocol (n=46) or antagonist protocol (n=61). Blood sample was obtained from each patient for progesterone level measurement in HCG administration day, then patients were divided into two groups according to their serum progesterone levels on the HCG triggering day: progesterone level <1.2 ng/ml, and progesterone level ≥1.2 ng/ml. Clinical pregnancy and miscarriage rates were evaluated as main outcomes and biochemical pregnancy rate and implantation rate were considered as secondary outcomes.
The increased prevalence rate of premature progesterone (progesterone level ≥1.2 ng/ml) in total patients was 13.1% (14/107) and in long agonist protocol group and antagonist protocol group was 15.2% (7/46) and 11.5% (7/61) respectively. Premature progesterone rise had no significant correlation with clinical pregnancy rate in total patients (p=0.174), agonist protocol (p=0.545), and antagonist protocol (p=0.129). Also premature progesterone rise had no significant association with miscarriage rate in total patients (p=0.077), agonist protocol group (p=0.383) and antagonist protocol group (p=0.087).
A significant rise in progesterone levels at the time of HCG triggering doesn't lead to decrease in pregnancy rate and implantation rate and increase in miscarriage rate.
在促性腺激素释放激素（GnRh）类似物应用之前，体外受精过程中过早黄素化的情况较为常见。高水平的不必要孕酮与不良妊娠结局相关，被认为是由不适当的促黄体生成素（LH）升高所诱导。
评估在GnRh激动剂和拮抗剂方案中，人绒毛膜促性腺激素（HCG）扳机日的孕酮水平，及其与临床妊娠率和流产率的相关性。
107名女性接受了卵胞浆内单精子注射，其中46名采用长效激动剂方案，61名采用拮抗剂方案。在HCG给药日采集每位患者的血样以测定孕酮水平，然后根据HCG扳机日的血清孕酮水平将患者分为两组：孕酮水平<1.2 ng/ml和孕酮水平≥1.2 ng/ml。将临床妊娠率和流产率作为主要结局进行评估，生化妊娠率和着床率作为次要结局。
总体患者中过早孕酮升高（孕酮水平≥1.2 ng/ml）的发生率为13.1%（14/107），长效激动剂方案组和拮抗剂方案组分别为15.2%（7/46）和11.5%（7/61）。过早孕酮升高与总体患者（p=0.174）、激动剂方案（p=0.545）和拮抗剂方案（p=0.129）的临床妊娠率均无显著相关性。过早孕酮升高与总体患者（p=0.077）、激动剂方案组（p=0.383）和拮抗剂方案组（p=0.087）的流产率也无显著关联。
HCG扳机时孕酮水平显著升高不会导致妊娠率和着床率降低以及流产率增加。
