Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Division of Infertility, Lee Women's Hospital, Taichung, Taiwan.
Front Endocrinol (Lausanne). 2020 Sep 15;11:653. doi: 10.3389/fendo.2020.00653. eCollection 2020.
Several studies have reported a poor implantation rate for assisted reproduction technology (ART) cycles with elevated progesterone (P4) at the end of the follicular phase. Whether all women with increased P4 on the human chorionic gonadotropin(hCG) trigger day should undergo fresh or frozen embryo transfer (ET) remains to be explored. This study attempted to determine that the P4 level on 2 days before hCG administration and P4 ratio can serve as indicators for fresh ET in normal responders with an elevated P4 level of >1.5 ng/ml on the hCG administration day. This was a retrospective cohort study involving 337 ART cycles with fresh ET for normal responders. Serum P4 levels were measured 2 days prior to hCG day (P4 level I) and on the hCG administration day (P4 level II). The P4 ratio was calculated as follows: P4 ratio = P4 level II / P4 level I. The primary outcome is live birth rate of fresh ET cycles. The ROC curves established that the optimal P4 level I and P4 ratio for pregnancy in ART cycles with high P4 level II were 0.975 ng/ml and 1.62, respectively. Patients with a P4 level I of ≤0.975 ng/ml and P4 ratio of >1.62 were associated with a significantly higher implantation (30.8%, 61/198 vs. 10.3%, 19/184, < 0.001) and live birth rates (51.6%, 33/64 vs. 15.0%, 9/60, < 0.001) compared with those with a P4 level I of >0.975 ng/ml and P4 ratio of ≤1.62. A combination of P4 level I and P4 ratio cutoff values of 0.975 ng/ml and 1.62, respectively, had a positive predictive value (PPV) of 82.5% for pregnancy. In conclusion, fresh ET can be an option for women with an early P4 level I under 0.975 ng/ml and a P4 ratio higher than 1.62, especially for those normal responders with an elevated P4 level II >1.5 ng/ml on the hCG administration day. This approach may shorten the time to pregnancy and reduce the cost of ART cycles.
一些研究报告称，在卵泡期结束时孕激素（P4）升高的辅助生殖技术（ART）周期中，着床率较差。在 hCG 触发日 P4 升高的所有女性是否都应该进行新鲜或冷冻胚胎移植（ET），仍有待探讨。本研究试图确定在 hCG 给药日前 2 天的 P4 水平和 P4 比值是否可以作为 hCG 给药日 P4 水平升高>1.5ng/ml 的正常反应者进行新鲜 ET 的指标。这是一项涉及 337 例正常反应者新鲜 ET 的 ART 周期的回顾性队列研究。在 hCG 日（P4 水平 I）前 2 天和 hCG 给药日（P4 水平 II）测量血清 P4 水平。P4 比值的计算公式如下：P4 比值= P4 水平 II / P4 水平 I。主要结局是新鲜 ET 周期的活产率。ROC 曲线确定，在 P4 水平 II 较高的 ART 周期中，P4 水平 I 和 P4 比值的最佳妊娠值分别为 0.975ng/ml 和 1.62。P4 水平 I 为≤0.975ng/ml 和 P4 比值>1.62 的患者，其着床率（30.8%，61/198 与 10.3%，19/184，<0.001）和活产率（51.6%，33/64 与 15.0%，9/60，<0.001）显著更高。与 P4 水平 I>0.975ng/ml 和 P4 比值≤1.62 的患者相比。P4 水平 I 和 P4 比值截断值分别为 0.975ng/ml 和 1.62 的组合对妊娠具有 82.5%的阳性预测值（PPV）。总之，对于 hCG 给药日 P4 水平 II 升高>1.5ng/ml 的正常反应者，尤其是早期 P4 水平 I<0.975ng/ml 和 P4 比值>1.62 的患者，新鲜 ET 可能是一种选择。这种方法可以缩短妊娠时间，降低 ART 周期的成本。
