Golbasi Hakan, Ince Onur, Golbasi Ceren, Ozer Mehmet, Demir Mustafa, Yilmaz Bulent
a Department of Obstetrics and Gynecology , Sakarya Akyazı State Hospital , Sakarya , Turkey.
b Department of Obstetrics and Gynecology , Bingöl Maternity and Pediatric Hospital , Bingöl , Turkey.
J Obstet Gynaecol. 2019 Feb;39(2):157-163. doi: 10.1080/01443615.2018.1504204. Epub 2018 Oct 3.
This study investigates the predictive power of serum progesterone/estradiol (P/E) level for estimating the live birth rate in patients who had a serum progesterone (P) rate ≥ 1.5 ng/mL on the human chorionic gonadotropin (hCG) administration day and who received the gonadotropin-releasing hormone (GnRH) antagonist protocol and intracytoplasmic sperm injection (ICSI). This retrospective cohort study included 176 cycles. The P/E ratio was lower in patients with a live birth (0.73 ± 0.54) than those without a live birth (1.05 ± 1.38), but the difference was not statistically significant (p = .158). According to the receiver operating characteristic curve analysis of the hCG day P/E ratio, the area under the curve was 0.579 (95% confidence interval: 0.478 - 0.680, p = .158) for predicting live birth. In conclusion, this study suggests that a P/E ratio is not a significant predictor of a live birth rate in the patients with an hCG-day serum progesterone level of ≥1.5 ng/mL undergoing GnRH antagonist ICSI cycles with a fresh embryo transfer. Impact statement What is already known on this subject? As the progesterone (P) levels in the late follicular phase correlate with the estradiol (E) levels and the increase in mature follicles, earlier studies have proposed the trigger-day progesterone/estradiol (P/E) ratio as a potential new marker for a premature luteinisation and live birth success. Most of these studies were conducted on long agonist cycles, and found that arbitrarily defined P/E ratio of >1 to be associated with poor pregnancy outcomes. What do the results of this study add? This study retrospectively examines the gonadotropin-releasing hormone (GnRH) antagonist cycles with a trigger-day serum P value of ≥1.5 ng/mL undergoing the intracytoplasmic sperm injection (ICSI) treatment. The receiver operating characteristic (ROC) curve analysis did not identify a statistically significant threshold value for the trigger-day P/E ratio that was beneficial in predicting a live birth. The P/E ratio was also lower in the cycles with a live birth than those without a live birth, although the difference was not statistically significant. What are the implications of these findings for clinical practice and/or further research? The trigger-day P/E ratio does not seem to be an efficient prognostic factor for a live birth in the GnRH antagonist ICSI cycles with a trigger-day serum progesterone level of ≥1.5 ng/mL. Further studies are needed to clarify the association of the trigger-day P/E ratio and the pregnancy outcomes in GnRH antagonist ICSI cycles.
本研究调查了血清孕酮/雌二醇（P/E）水平对估算在人绒毛膜促性腺激素（hCG）给药日血清孕酮（P）水平≥1.5 ng/mL且接受促性腺激素释放激素（GnRH）拮抗剂方案和卵胞浆内单精子注射（ICSI）的患者活产率的预测能力。这项回顾性队列研究纳入了176个周期。活产患者的P/E比值（0.73±0.54）低于未活产患者（1.05±1.38），但差异无统计学意义（p = 0.158）。根据hCG日P/E比值的受试者工作特征曲线分析，预测活产的曲线下面积为0.579（95%置信区间：0.478 - 0.680，p = 0.158）。总之，本研究表明，对于hCG日血清孕酮水平≥1.5 ng/mL且接受GnRH拮抗剂ICSI周期并进行新鲜胚胎移植的患者，P/E比值并非活产率的显著预测指标。影响声明关于该主题已了解哪些内容？由于卵泡晚期的孕酮（P）水平与雌二醇（E）水平及成熟卵泡的增加相关，早期研究提出触发日孕酮/雌二醇（P/E）比值作为过早黄素化和活产成功的潜在新标志物。这些研究大多在长效激动剂周期中进行，发现任意定义的P/E比值>1与不良妊娠结局相关。本研究结果有何补充？本研究回顾性分析了触发日血清P值≥1.5 ng/mL且接受卵胞浆内单精子注射（ICSI）治疗的促性腺激素释放激素（GnRH）拮抗剂周期。受试者工作特征（ROC）曲线分析未确定触发日P/E比值在预测活产方面有益的统计学显著阈值。活产周期的P/E比值也低于未活产周期，尽管差异无统计学意义。这些发现对临床实践和/或进一步研究有何意义？对于触发日血清孕酮水平≥1.5 ng/mL的GnRH拮抗剂ICSI周期，触发日P/E比值似乎不是活产的有效预后因素。需要进一步研究以阐明触发日P/E比值与GnRH拮抗剂ICSI周期妊娠结局之间的关联。
