Forman R, Fries N, Testart J, Belaisch-Allart J, Hazout A, Frydman R
Institut National de la Santé et de la Recherche Médicale, Unite 187, Department of Obstetrics and Gynaecology, Hôpital Antoine Béclère, Clamart France.
Fertil Steril. 1988 Jan;49(1):118-22. doi: 10.1016/s0015-0282(16)59661-7.
Multiple follicular stimulation for IVF may be associated with greatly elevated serum E2 concentrations that are presumed to be antinidatory. This factor was analyzed in 825 consecutive embryo transfer cycles. The pregnancy rate decreased significantly after the transfer of one and two embryos in association with preovulatory E2 levels greater than the 90th percentile for the group (2320 pg/ml). The pregnancy rate did not vary with preovulatory E2 concentration following the transfer of three embryos. Highly significant correlations were noted between preovulatory E2 and early luteal phase concentrations of E2 and P. In a subgroup of 245 cycles, there were no significant relationships between implantation and early luteal phase levels of P or the ratio of E2/P. There was a small but nonsignificant tendency for the pregnancy rate to decrease in association with raised luteal E2. It is concluded that excessive E2 levels at the time of ovulation induction with hCG had an adverse effect on implantation when one or two embryos are transferred, but this may be overcome by the transfer of three embryos. The consequences for embryo transfer are discussed.
体外受精的多次卵泡刺激可能与血清雌二醇（E2）浓度大幅升高有关，这种升高被认为具有抗着床作用。在连续825个胚胎移植周期中对该因素进行了分析。在移植1个和2个胚胎后，若排卵前E2水平高于该组第90百分位数（2320 pg/ml），妊娠率会显著下降。移植3个胚胎后，妊娠率并未随排卵前E2浓度而变化。排卵前E2与黄体早期E2和孕酮（P）浓度之间存在高度显著的相关性。在245个周期的亚组中，着床与黄体早期P水平或E2/P比值之间无显著关系。黄体期E2升高时，妊娠率有轻微但不显著的下降趋势。结论是，在使用人绒毛膜促性腺激素（hCG）诱导排卵时，过高的E2水平在移植1个或2个胚胎时会对着床产生不利影响，但移植3个胚胎可能会克服这一问题。文中还讨论了对胚胎移植的影响。
