Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, 1411713135, Shariati Hospital, Jalal-e-Al-e-Ahmad Hwy, Tehran, Iran.
Reprod Biol Endocrinol. 2021 Feb 18;19(1):24. doi: 10.1186/s12958-021-00703-6.
Previous observational studies have highlighted the negative effects of serum hormone levels at the minimum threshold during frozen embryo transfer (FET) cycles. However, still the questions regarding the maximum threshold level, and the highest allowed dosage of hormonal medications remain unresolved. The present study was conducted to determine whether there is any relationship between the serum progesterone and estradiol levels on the day of ET, and live birth rate (LBR) in patients receiving HRT in FET cycles.
In this prospective cohort study, eligible women who were undergoing their first or second FET cycles with the top graded blastocyst stage embryos were included. All patients received the same HRT regimen. FET was scheduled 5 days after administration of the first dosage of progesterone. On the morning of ET, 4-6 h after the last dose of progesterone supplementation, the serum progesterone (P ng/ml) and estradiol (E, pg/ml) levels were measured.
Amongst the 258 eligible women that were evaluated, the overall LBR was 34.1 % (88/258). The serum P and E values were divided into four quartiles. The means of women's age and BMI were similar between the four quartiles groups. Regarding both P and E values, it was found that the LBR was significantly lower in the highest quartile group (Q) compared with the others, (P = 0.002 and P = 0.042, respectively). The analysis of the multivariable logistic regression showed that the serum level of P on ET day, was the only significant predictive variable for LBR. The ROC curve revealed a significant predictive value of serum P levels on the day of ET for LBR, with an AUC = 0.61 (95 % CI: 0.54-0.68, P = 0.002). The optimum level of serum P, with 70 % sensitivity and 50 %specificity for LBR, was 32.5 ng/ml.
The present study suggests that a serum P4 value at the maximum threshold on the day of FET is associated with reduced LBR following blastocyst transfer. Therefore, measuring and monitoring of P levels during FET cycles might be necessary. However, the results regarding the necessity for the screening of serum E levels before ET, are still controversial, and further prospective studies are required.
先前的观察性研究强调了在冷冻胚胎移植（FET）周期中血清激素水平达到最低阈值时的负面影响。然而，关于最高阈值水平以及激素药物的最高允许剂量的问题仍未得到解决。本研究旨在确定在接受 FET 周期 HRT 的患者中，ET 日血清孕激素和雌二醇水平是否与活产率（LBR）相关。
在这项前瞻性队列研究中，纳入了接受顶级评分的囊胚阶段胚胎进行首次或第二次 FET 周期的合格女性。所有患者均接受相同的 HRT 方案。FET 计划在首次孕激素剂量给药后 5 天进行。在 ET 当天，在最后一次孕激素补充剂量后 4-6 小时，测量血清孕激素（P，ng/ml）和雌二醇（E，pg/ml）水平。
在 258 名接受评估的合格女性中，整体活产率为 34.1%（88/258）。将血清 P 和 E 值分为四个四分位数。四组间女性年龄和 BMI 的平均值相似。关于 P 和 E 值，发现最高四分位组（Q）的活产率明显低于其他组（P=0.002 和 P=0.042）。多变量逻辑回归分析显示，ET 日血清 P 水平是 LBR 的唯一显著预测变量。ROC 曲线显示 ET 日血清 P 水平对 LBR 具有显著的预测价值，AUC=0.61（95%CI：0.54-0.68，P=0.002）。血清 P 水平的最佳水平为 70%的敏感性和 50%的特异性，用于预测 LBR，为 32.5ng/ml。
本研究表明，FET 日血清 P4 值达到最高阈值与囊胚转移后 LBR 降低有关。因此，在 FET 周期中测量和监测 P 水平可能是必要的。然而，关于在 ET 前筛查血清 E 水平的必要性的结果仍存在争议，需要进一步的前瞻性研究。
