Ashmita Jawa, Vikas Swarankar, Swati Garg
Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
J Hum Reprod Sci. 2017 Oct-Dec;10(4):265-270. doi: 10.4103/0974-1208.223278.
Premature progesterone rise (PPR) has long been implicated as contributing to implantation failure. Despite the use of gonadotropin-releasing hormone (GnRH) analogues, subtle increases in serum progesterone () levels beyond a threshold progesterone concentration were observed on the day of trigger in controlled ovarian hyperstimulation cycles.
The purpose of the study was to evaluate the incidence of PPR on the day of trigger in conventional IVF/ICSI cycles and its impact on clinical pregnancy rate.
A total of 235 patients undergoing conventional IVF/IVF-ICSI by fresh embryo transfer cycles from January 2016 to December 2016 at the infertility unit of a tertiary care hospital were prospectively analyzed.
Patients included in the study were subjected to GnRH agonist long/antagonist protocol. Ovulation induction was given with rFSH and/or HMG in both the protocols. The cutoff for defining PPR was ≥ 1.5 ng/ml, and an analysis of the role of on clinical pregnancy rate was performed. Statistical analysis was performed with the Statistical Package for the Social Sciences trial version 23.0 software for Windows and Primer software.
The overall clinical pregnancy rate per embryo transfer was 30.6%. The clinical pregnancy rate in the patients with <1.5 ng/ml was significantly higher than those with elevated levels, ≥ 1.5 ng/ml (33.3% vs. 12.9%; = 0.037). Premature progesterone elevation in ART cycles is possibly associated with lower clinical pregnancy rates.
长期以来，过早的孕酮升高（PPR）一直被认为是导致着床失败的原因。尽管使用了促性腺激素释放激素（GnRH）类似物，但在控制性卵巢过度刺激周期中，触发日血清孕酮（P）水平仍会出现超过阈值孕酮浓度的细微升高。
本研究旨在评估常规体外受精/卵胞浆内单精子注射（IVF/ICSI）周期中触发日PPR的发生率及其对临床妊娠率的影响。
前瞻性分析了2016年1月至2016年12月在一家三级医院不孕不育科接受新鲜胚胎移植周期常规IVF/IVF-ICSI的235例患者。
纳入研究的患者采用GnRH激动剂长方案/拮抗剂方案。两种方案均使用重组促卵泡生成素（rFSH）和/或人绝经期促性腺激素（HMG）进行促排卵。定义PPR的临界值为≥1.5 ng/ml，并分析P对临床妊娠率的作用。使用适用于Windows的社会科学统计软件包试用版23.0软件和Primer软件进行统计分析。
每次胚胎移植的总体临床妊娠率为30.6%。P<1.5 ng/ml的患者临床妊娠率显著高于P水平升高（≥1.5 ng/ml）的患者（33.3%对12.9%；P = 0.037）。辅助生殖技术（ART）周期中过早的孕酮升高可能与较低的临床妊娠率有关。
