Mutlu Mehmet Firat, Erdem Mehmet, Erdem Ahmet, Mutlu Ilknur, Guler Ismail, Demirdağ Erhan
Department of Obstetrics & Gynecology, Yuksek Ihtisas University Faculty of Medicine, Ankara, Turkey.
Department of Obstetrics & Gynecology, Gazi University Faculty of Medicine, Ankara, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:44-8. doi: 10.1016/j.ejogrb.2016.05.013. Epub 2016 May 20.
To ascertain the incidence of premature progesterone P rise and its impact on outcomes in controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) cycles, and also to identify variables related with premature P rise.
Four hundred sixty cycles of 460 couples with unexplained infertility having COH-IUI treatment with a starting dose of 75IU recombinant FSH enrolled in this prospective study. Serum P levels were determined on the day of hCG trigger. Premature P rise was defined as progesterone ≥1ng/mL. The primary outcome measure was live birth per cycle with regard to P levels of ≥1ng/mL and ≥1.5ng/mL. Secondary outcome measures were cycle characteristics associated with P rise.
The incidence of premature P rise was 22.0%. P levels on hCG day were significantly lower in cycles with live birth as compared to cycles without live birth 0.49±0.51 vs. 0.73±0.82ng/mL. Live birth rates were significantly lower in cycles with hCG day P levels ≥1.0ng/mL (%7.9 vs. %22.6) and ≥1.5ng/mL (%6.4 vs. %20.8). Among age, number of dominant follicles, estradiol, LH and P levels on the day of hCG trigger, it was found that P levels was the only significant variable to predict live birth on multivariate analysis. The number of dominant follicles on hCG day and premature LH surge were the only significant variables related with premature P rise.
Premature P is a frequent feature of COH-IUI cycles and associated with decreased live birth rates.
确定在控制性卵巢过度刺激及宫腔内人工授精（COH-IUI）周期中孕激素过早升高的发生率及其对结局的影响，并识别与孕激素过早升高相关的变量。
本前瞻性研究纳入了460对不明原因不孕症夫妇的460个COH-IUI周期，起始剂量为75IU重组促卵泡激素。在注射人绒毛膜促性腺激素（hCG）当天测定血清孕激素水平。孕激素过早升高定义为孕激素≥1ng/mL。主要结局指标是根据孕激素水平≥1ng/mL和≥1.5ng/mL计算的每个周期的活产率。次要结局指标是与孕激素升高相关的周期特征。
孕激素过早升高的发生率为22.0%。与未活产的周期相比，活产周期中hCG日的孕激素水平显著更低（0.49±0.51 vs. 0.73±0.82ng/mL）。hCG日孕激素水平≥1.0ng/mL（7.9% vs. 22.6%）和≥1.5ng/mL（6.4% vs. 20.8%）的周期中活产率显著更低。在年龄、优势卵泡数量、hCG激发日的雌二醇、促黄体生成素（LH）和孕激素水平中，多因素分析发现孕激素水平是预测活产的唯一显著变量。hCG日优势卵泡数量和LH过早高峰是与孕激素过早升高相关的仅有的显著变量。
孕激素过早升高是COH-IUI周期的常见特征，且与活产率降低相关。
