Division of Gynecology and Reproductive Medicine, Department of Gynecology, Fertility Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.
Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
Front Endocrinol (Lausanne). 2020 Sep 23;11:547684. doi: 10.3389/fendo.2020.547684. eCollection 2020.
To assess the association between serum ovulation trigger progesterone (P) levels and the outcome of fertilization cycles. Real world single-center retrospective cohort study. All fresh cleavage and blastocyst-stage embryo transfers (ETs) performed from January 2012 to December 2016. The impact of premature high serum P levels cycles in terms of clinical pregnancy rates (CPRs) and live birth rates (LBRs). 8,034 ETs were performed: 7,597 cleavage-stage transfers and 437 blastocyst transfers. Serum P levels demonstrated to be inversely related to CPR (OR 0.72, < 0.001) and LBR (OR 0.73, < 0.001). The progressive decrease of LBR and CPR started when P levels were >1 ng/ml in a good prognosis cleavage ET subgroup, whereas in patients with worse prognosis only for ≥ 1.75 ng/ml. In the blastocyst ET subgroup, the negative effect of P elevation was reported only if P was >1.75 ng/ml. CPR (OR 0.71 (0.62-0.80), < 0.001) and LBR (OR 0.73 (0.63-0.84), < 0.001) in thawed cycles resulted statistically significantly higher than in fresh cycles in the cleavage-stage subgroup. In the blastocyst group, no significant difference resulted between thawed and fresh cycles, independently of P levels [CPR OR 0. 37 (0.49-1.09), = 0.123; LBR OR 0.71 (0.46-1.10), = 0.126]. High P levels decrease CPR as well as LBR in both cleavage and blastocyst ET. In the cleavage group, for P levels below 1.75 ng/ml, our data suggest the possibility to wait until day 5 for ET, and if P level is ≥1.75 ng/ml, it should be considered to freeze all embryos and postpone the ET. ClinicalTrials.gov, ID: NCT04253470.
评估血清排卵触发孕激素 (P) 水平与受精周期结局的关系。 真实世界的单中心回顾性队列研究。 2012 年 1 月至 2016 年 12 月进行的所有新鲜卵裂期和囊胚期胚胎移植 (ET)。 探讨高血清 P 水平对临床妊娠率 (CPR) 和活产率 (LBR) 的影响。 共进行了 8034 次 ET：7597 次卵裂期转移和 437 次囊胚转移。血清 P 水平与 CPR (OR 0.72，<0.001) 和 LBR (OR 0.73，<0.001) 呈负相关。当 P 水平 >1ng/ml 时，在预后良好的卵裂 ET 亚组中，LBR 和 CPR 逐渐下降，而在预后较差的患者中，仅当 P 水平≥1.75ng/ml 时才会下降。在囊胚 ET 亚组中，仅当 P 升高>1.75ng/ml 时，才会报告 P 升高的负面影响。解冻周期的 CPR (OR 0.71(0.62-0.80)，<0.001) 和 LBR (OR 0.73(0.63-0.84)，<0.001) 明显高于卵裂期亚组的新鲜周期。在囊胚组中，无论 P 水平如何，解冻周期与新鲜周期之间均无显著差异[CPR OR 0.37(0.49-1.09)，=0.123；LBR OR 0.71(0.46-1.10)，=0.126]。高 P 水平降低卵裂和囊胚 ET 的 CPR 和 LBR。在卵裂组中，对于 P 水平低于 1.75ng/ml，我们的数据表明可以等到第 5 天进行 ET，如果 P 水平≥1.75ng/ml，则应考虑冷冻所有胚胎并推迟 ET。 ClinicalTrials.gov，ID：NCT04253470。
