Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101-1090 Brussels, Belgium.
Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino-IST, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy.
Hum Reprod. 2018 May 1;33(5):860-868. doi: 10.1093/humrep/dey031.
Is elevated late-follicular phase progesterone (EP) associated with a deleterious impact on embryo quality (EQ) and cumulative live birth rates (LBRs)?
EP was associated with a decrease in embryo utilization and cumulative LBRs.
Ovarian stimulation promotes the production of progesterone (P) which adversely affects IVF pregnancy outcomes. However, evidence regarding a potential association between EP an EQ is lacking.
STUDY DESIGN, SIZE, DURATION: A retrospective analysis of all GnRH antagonist down-regulated ICSI cycles followed by a fresh embryo transfer (ET) between 2010 and 2015 was performed. The sample was stratified according to the following P levels on the day of ovulation triggering: ≤0.50, 0.51-1.49 and ≥1.50 ng/ml. The primary outcomes were embryo utilization rates (number of embryos transferred or cryopreserved) and cumulative LBR, defined as the occurrence of the first live-birth after either the fresh or one of the subsequent frozen ET.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall, 3400 cycles were included in the analysis, using multivariable regression to account for potential confounding.
Female age and the number of oocytes retrieved increased significantly with increasing serum P values. Utilization rates decreased linearly as P increased for Day 3 embryos (72.3, 63.0 and 45.4%, respectively), while for Day 5 embryos only the EP group was associated with a significant decrease (48.8, 47.8 and 38.8%, respectively). EP was also associated with decreased fresh and cumulative LBRs.
The main limitations of this study were its retrospective nature and the fact that it was restricted to GnRH antagonist cycles.
These results raise the question whether EP may also be associated with a decrease in cumulative pregnancy outcomes by increasing embryo wastage. Further studies may evaluate the potential benefit of additional measures besides the freeze-all strategy to avoid this issue, such as lowering the stimulation dose or applying a step-down protocol.
STUDY FUNDING/COMPETING INTEREST(S): None.
黄体中期孕酮（EP）升高是否与胚胎质量（EQ）和累积活产率（LBR）的不良影响有关？
EP 与胚胎利用率和累积 LBR 的下降有关。
卵巢刺激会促进孕酮（P）的产生，这会对 IVF 妊娠结局产生不利影响。然而，关于 EP 与 EQ 之间潜在关联的证据尚缺乏。
研究设计、规模、持续时间：对 2010 年至 2015 年期间进行的所有 GnRH 拮抗剂下调的 ICSI 周期进行了回顾性分析，随后进行了新鲜胚胎移植（ET）。根据排卵触发日的以下 P 水平对样本进行分层：≤0.50、0.51-1.49 和≥1.50ng/ml。主要结局是胚胎利用率（转移或冷冻保存的胚胎数量）和累积 LBR，定义为新鲜或随后的一次冷冻 ET 后首次活产。
参与者/材料、设置、方法：共有 3400 个周期纳入分析，采用多变量回归来考虑潜在的混杂因素。
女性年龄和获得的卵母细胞数量随着血清 P 值的增加而显著增加。随着 P 值的升高，第 3 天胚胎的利用率呈线性下降（分别为 72.3%、63.0%和 45.4%），而第 5 天胚胎仅 EP 组与显著下降相关（分别为 48.8%、47.8%和 38.8%）。EP 还与新鲜和累积 LBR 的降低有关。
局限性/谨慎的原因：本研究的主要局限性是其回顾性性质以及仅限于 GnRH 拮抗剂周期。
这些结果提出了一个问题，即 EP 是否也可能通过增加胚胎浪费而与累积妊娠结局的下降有关。进一步的研究可能会评估除了冷冻所有策略之外，还可以采取哪些额外措施来避免这个问题，例如降低刺激剂量或应用逐步降低方案。
研究资金/竞争利益（无）。
