促排卵前血清雌二醇水平下降是预测自然/非刺激体外受精周期中发生过早排卵的有价值的标志物。
Decrease in preovulatory serum estradiol is a valuable marker for predicting premature ovulation in natural/unstimulated in vitro fertilization cycle.
机构信息
Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Rd, Shanghai, 200011, China.
Department of Assisted Reproduction, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, 200120, China.
出版信息
J Ovarian Res. 2018 Nov 21;11(1):96. doi: 10.1186/s13048-018-0469-x.
BACKGROUND
Premature ovulation occurs at a high rate in natural-cycle in vitro fertilization (IVF), and cycle cancellation further hampers the overall efficiency of the procedure. While lower levels of estradiol (E2) are observed in preovulatory follicles, it is unclear whether declines in E2 can be used as an effective marker of premature ovulation.
METHODS
This retrospective analysis includes 801 natural/unstimulated IVF/ICSI cycles undergoing scheduled ovum pick-up (OPU) and 153 natural/unstimulated IVF/ICSI cycles undergoing emergency OPU at a university IVF center from May 2014 to February 2017.
RESULTS
Among the 801 IVF/ICSI cycles undergoing scheduled OPU, preovulatory E2 levels increased by more than 10% in 403 (50.31%) cycles of the sample (Group A), while 192 (23.97%) cycles experienced a plateau (increased or decreased by 10%; Group B), and 206 (25.72%) cycles decreased by more than 10% (Group C). Group C had more patients who experienced premature LH surges, premature ovulation, as well as the fewest oocytes retrieved, frozen embryos, and top-quality embryos. A multivariate logistic regression analysis indicated that premature ovulation was associated with preovulatory E2/-1E2 ratio and premature LH surge. Moreover, preovulatory E2/-1E2 ratio served as a valuable marker for differentiating premature ovulation, with an AUC (area under the receiver operating curve) of 0.708 and 0.772 in cycles with premature LH surges and cycles without premature LH surges, respectively. Emergency OPU resulted in a significantly decreased rate of premature ovulation and increased number of frozen embryos.
CONCLUSION
Decreases in preovulatory serum E2 was a valuable marker for premature ovulation in natural/unstimulated IVF cycle. Emergency OPU based on the preovulatory E2/-1E2 ratio decreased the rate of premature ovulation in cycles that experienced E2 decreases.
背景
自然周期体外受精（IVF）中排卵过早的发生率很高，而取消周期进一步降低了该过程的整体效率。虽然在排卵前卵泡中观察到雌二醇（E2）水平较低，但尚不清楚 E2 水平下降是否可作为排卵过早的有效标志物。
方法
本回顾性分析纳入了 2014 年 5 月至 2017 年 2 月在一所大学 IVF 中心接受计划取卵（OPU）的 801 个自然/未刺激的 IVF/ICSI 周期和 153 个接受紧急 OPU 的自然/未刺激的 IVF/ICSI 周期。
结果
在 801 个接受计划 OPU 的 IVF/ICSI 周期中，样本中 403 个（50.31%）周期的促黄体生成素（LH）前 E2 水平增加超过 10%（A 组），192 个（23.97%）周期出现平台期（增加或减少 10%；B 组），而 206 个（25.72%）周期下降超过 10%（C 组）。C 组中发生排卵过早、LH 过早激增、获卵数、冷冻胚胎和优质胚胎数较少的患者更多。多变量逻辑回归分析表明，排卵过早与促黄体生成素前 E2/-1E2 比值和 LH 过早激增相关。此外，促黄体生成素前 E2/-1E2 比值可作为区分排卵过早的有价值标志物，在出现 LH 过早激增的周期和未出现 LH 过早激增的周期中，其 AUC（接收者操作特征曲线下面积）分别为 0.708 和 0.772。紧急 OPU 可显著降低排卵过早的发生率并增加冷冻胚胎数。
结论
促黄体生成素前血清 E2 下降是自然/未刺激 IVF 周期排卵过早的有价值标志物。基于促黄体生成素前 E2/-1E2 比值的紧急 OPU 可降低出现 E2 下降的周期中排卵过早的发生率。
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