促性腺激素刺激的卵母细胞供体中低雌二醇反应并不影响临床结局。
Low estradiol responses in oocyte donors undergoing gonadotropin stimulation do not influence clinical outcomes.
机构信息
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Columbia University Fertility Center, 5 Columbus Circle, PH, New York, NY, 10019, USA.
出版信息
J Assist Reprod Genet. 2018 Sep;35(9):1675-1682. doi: 10.1007/s10815-018-1192-7. Epub 2018 Apr 27.
PURPOSE
To examine the effect of low and very low estradiol responses in oocyte donors receiving gonadotropins on clinical outcomes of donor in vitro fertilization (IVF) cycles and to identify possible mechanisms responsible for low estradiol response.
METHODS
This is a retrospective cohort study of oocyte donors undergoing antagonist IVF cycles with progression to oocyte retrieval between January 2010 and December 2016 at a single urban academic fertility center. Oocyte yield, fertilization rate, blastocyst rate, percentage of normal embryos on preimplantation genetic screening (PGS), pregnancy outcomes, and follicular fluid steroid profiles were compared between donors with normal estradiol response and those with low estradiol response.
RESULTS
Three hundred sixty-six antagonist oocyte donor IVF cycles were identified: 42 cycles had a normal estradiol response (NE2), defined as peak serum estradiol (E2) of over 200 pg/mL per retrieved oocyte; 140 cycles had an intermediate estradiol response (iE2), defined as peak serum E2 between 100 and 200 pg/mL per retrieved oocyte; 110 cycles had a low estradiol response (LE2), defined as peak serum E2 between 50 and 100 pg/mL per retrieved oocyte; and 74 cycles had a very low estradiol response (vLE2), defined as peak serum E2 less than 50 pg/mL per retrieved oocyte. LE2 cycles resulted in a greater number of mature oocytes (22.4 vs. 13.6, p < 0.017), and fertilizations versus NE2 donors (18.5 vs. 10.7, p < 0.017), although the number of transferred or cryopreserved blastocysts were similar between groups (8.6, 6.9 vs. 4.8, p = 0.095, p = 1). The percentage of chromosomally normal embryos after PGS was similar between LE2, vLE2, and NE2 cycles (66.4, 71.8 vs. 63.1%, p = 0.99, p = 1). Pregnancy outcomes were similar between LE2, vLE2, and NE2 cycles. Serum AMH obtained on the day of peak E2 was similar to baseline serum AMH and did not differ between LE2 versus NE2 cycles. Follicular fluid E2 levels paralleled serum E2 levels and were lower in LE2 cycles versus NE2 cycles.
CONCLUSION
The prevalence of very low E2 responses in donors appears to be high (20.2%). In contrast to autologous IVF cycles, LE2 does not portend poor outcomes in oocyte donors.
目的
研究接受促性腺激素治疗的卵母细胞供体中低雌激素和极低雌激素反应对供体体外受精（IVF）周期临床结局的影响，并确定导致低雌激素反应的可能机制。
方法
这是一项回顾性队列研究，纳入了 2010 年 1 月至 2016 年 12 月在一家单中心城市学术生育中心接受拮抗剂 IVF 周期并进行卵母细胞采集的卵母细胞供体。比较了雌激素反应正常的供体（NE2）与雌激素反应低的供体（LE2）的卵母细胞产量、受精率、囊胚率、植入前遗传学筛查（PGS）的正常胚胎百分比、妊娠结局和卵泡液甾体谱。
结果
共确定了 366 个拮抗剂卵母细胞供体 IVF 周期：42 个周期雌激素反应正常（NE2），定义为每个取卵的卵母细胞的血清雌二醇（E2）峰值超过 200pg/mL；140 个周期雌激素反应中等（iE2），定义为每个取卵的卵母细胞的血清 E2 峰值在 100-200pg/mL 之间；110 个周期雌激素反应低（LE2），定义为每个取卵的卵母细胞的血清 E2 峰值在 50-100pg/mL 之间；74 个周期雌激素反应极低（vLE2），定义为每个取卵的卵母细胞的血清 E2 峰值低于 50pg/mL。LE2 周期产生了更多的成熟卵母细胞（22.4 个 vs. 13.6 个，p<0.017），与 NE2 供体相比，受精率更高（18.5 个 vs. 10.7 个，p<0.017），尽管两组之间转移或冷冻的囊胚数量相似（8.6 个，6.9 个 vs. 4.8 个，p=0.095，p=1）。PGS 后正常染色体胚胎的百分比在 LE2、vLE2 和 NE2 周期之间相似（66.4%、71.8% vs. 63.1%，p=0.99，p=1）。LE2、vLE2 和 NE2 周期的妊娠结局相似。在 E2 峰值日获得的血清 AMH 与基线血清 AMH 相似，并且在 LE2 与 NE2 周期之间没有差异。卵泡液 E2 水平与血清 E2 水平平行，并且在 LE2 周期中低于 NE2 周期。
结论
供体中极低 E2 反应的发生率似乎很高（20.2%）。与自体 IVF 周期不同，LE2 并不会给卵母细胞供体带来不良结局。
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