The Fertility Clinic, Skive Regional Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
The Fertility Clinic, Skive Regional Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
Reprod Biomed Online. 2018 Nov;37(5):641-647. doi: 10.1016/j.rbmo.2018.08.022. Epub 2018 Oct 6.
Do serum progesterone levels determine ongoing pregnancy rates (OPR) in hormone replacement therapy frozen-thawed embryo transfer (HRT-FET) cycles?
A cohort study of 244 HRT-FET cycles from a Danish public fertility centre. Data from patients undergoing HRT-FET from January 2016 to December 2017 were extracted from a clinical database. All patients had transfer in HRT cycles of autologous embryos frozen on day 5 or 6. Endometrial preparation was performed using 6 mg oestradiol valerate daily from the second day of the cycle followed by vaginal micronized progesterone (90 mg/8 h). All patients had serum progesterone measurement during the artificial luteal phase.
The optimal cut-off for ongoing pregnancy was 35 nmol/l based on sensitivity analysis of different progesterone levels as a factor variable and its association with ongoing pregnancy. No significant differences regarding number of embryos transferred, embryo quality, age, body mass index (BMI) or smoking were found in the two groups of progesterone < 35 nmol/l and ≥ 35 nmol/l, respectively. A total of 51% of patients had a serum progesterone < 35 nmol/l. The range of all measurements was 0.3 to 110 nmol/l. The unadjusted OPR was significantly lower in the < 35 nmol/l group compared with the ≥ 35 nmol/l group (38% versus 51%;P = 0.04). A logistic regression analysis, adjusting for smoking, age, BMI, number of embryos transferred and blastocyst age showed a significant decrease in OPR when progesterone was < 35 nmol/l of 44% (95% confidence interval [CI] 35-54%) compared with ≥ 35 nmol/l of 58% (95% CI 48-68%), risk difference of 14% (95% CI 2-26%,P = 0.02).
Serum progesterone levels < 35 nmol/l decrease the chance of OPR in HRT-FET cycles.
在激素替代治疗冷冻胚胎移植（HRT-FET）周期中，血清孕激素水平是否决定持续妊娠率（OPR）？
这是一项来自丹麦公共生育中心的 244 例 HRT-FET 周期的队列研究。从 2016 年 1 月至 2017 年 12 月接受 HRT-FET 的患者数据从临床数据库中提取。所有患者均在第 5 或第 6 天接受自体胚胎冷冻的 HRT 周期中进行转移。子宫内膜准备从周期的第二天开始，每天使用 6mg 戊酸雌二醇，然后阴道给予微粒化孕酮（90mg/8h）。所有患者在人工黄体期进行血清孕激素检测。
根据不同孕激素水平作为因素变量及其与持续妊娠的关系的敏感性分析，持续妊娠的最佳截断值为 35nmol/L。孕激素<35nmol/L 和≥35nmol/L 两组之间，胚胎转移数量、胚胎质量、年龄、体重指数（BMI）或吸烟情况无显著差异。共有 51%的患者血清孕激素<35nmol/L。所有测量值的范围为 0.3 至 110nmol/L。未调整的 OPR 在孕激素<35nmol/L 组明显低于孕激素≥35nmol/L 组（38%比 51%；P=0.04）。调整吸烟、年龄、BMI、胚胎转移数量和囊胚年龄后，logistic 回归分析显示，当孕激素<35nmol/L 时，OPR 显著下降 44%（95%CI 35-54%），而孕激素≥35nmol/L 时，OPR 显著下降 58%（95%CI 48-68%），风险差异为 14%（95%CI 2-26%，P=0.02）。
血清孕激素水平<35nmol/L 降低了 HRT-FET 周期中 OPR 的机会。
