Thomsen Lise Haaber, Kesmodel Ulrik Schiøler, Andersen Claus Yding, Humaidan Peter
The Fertility Clinic, Skive Regional Hospital, Skive, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Front Endocrinol (Lausanne). 2018 Mar 19;9:92. doi: 10.3389/fendo.2018.00092. eCollection 2018.
To investigate whether mid-luteal serum progesterone (P) exhibits significant fluctuations during a 12-h daytime period in women undergoing fertilization (IVF) and to explore whether the extent of these fluctuations could impact the interpretation of luteal progesterone levels in a clinical setting.
Explorative pilot study.
Public hospital-based fertility unit.
Ten women undergoing IVF treatment.
Seven days after oocyte pick-up, patients underwent frequent repeated blood sampling (every 60 min for 12 h and during two of these hours, every 15 min). Serum samples were analyzed for progesterone, estradiol, and luteinizing hormone (LH).
Daytime fluctuations in s-progesterone and s-estradiol.
There was a significant positive correlation between median P levels and the magnitude of P variations-women with median P < 60 nmol/l had clinically stable P levels throughout the day, while patients with median P > 250 nmol/l exhibited periodic P peaks of several hundred nanomoles per liter. These endogenous P fluctuations were observed irrespective of the type of stimulation protocol or mode of triggering of final oocyte maturation and despite the fact that LH was under the detection limit at the time of measurement. Simultaneously, large fluctuations were seen in s-estradiol.
Monitoring of early to mid-luteal P levels in IVF cycles may be valuable in the planning of individualized luteal phase support in the attempt to increase reproductive outcomes. The prerequisite for luteal phase monitoring is, however, that the validity of a single measured P value is reliable. We show for the first time, that a single P measurement in the low progesterone patient quite accurately reflects the corpus luteum function and that the measurement can be used to detect IVF patients with a need of additional exogenous luteal P administration.
研究接受体外受精（IVF）的女性在白天12小时期间黄体中期血清孕酮（P）是否存在显著波动，并探讨这些波动程度是否会影响临床环境中黄体期孕酮水平的解读。
探索性试点研究。
公立医院的生殖科。
10名接受IVF治疗的女性。
取卵后7天，患者接受频繁重复采血（每60分钟一次，共12小时，其中两小时每15分钟一次）。分析血清样本中的孕酮、雌二醇和促黄体生成素（LH）。
血清孕酮和血清雌二醇的日间波动。
P的中位数水平与P变化幅度之间存在显著正相关——P中位数<60 nmol/l的女性全天P水平临床稳定，而P中位数>250 nmol/l的患者出现每升数百纳摩尔的周期性P峰值。无论刺激方案类型或最终卵母细胞成熟的触发方式如何，均观察到这些内源性P波动，尽管测量时LH低于检测限。同时，血清雌二醇也出现了大幅波动。
在IVF周期中监测黄体早期至中期的P水平，对于规划个体化的黄体期支持以提高生殖结局可能具有重要价值。然而，黄体期监测的前提是单次测量的P值的有效性可靠。我们首次表明，低孕酮患者的单次P测量能相当准确地反映黄体功能，且该测量可用于检测需要额外外源性黄体期P给药的IVF患者。
