Hussein Reda S, Elnashar Ihab, Abou-Taleb Hisham A, Zhao Yulian, Abdelmagied Ahmed M, Abbas Ahmed M, Abdalmageed Osama S, Abdelaleem Ahmed A, Farghaly Tarek A, Youssef Ahmed A, Badran Esraa, Ibrahim Mostafa N, Amin Ahmed F
Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA.
J Hum Reprod Sci. 2021 Jan-Mar;14(1):28-35. doi: 10.4103/jhrs.JHRS_57_20. Epub 2021 Mar 30.
Several parameters were proposed to predict the impact of premature luteinization on intracytoplasmic sperm injection (ICSI) outcomes such as isolated progesterone (P) level, progesterone to oocyte ratio, and progesterone/estradiol ratio (P/E2).
The aim of this study is to compare the predictive value of P/E2 ratio and isolated P level on the ovulation triggering day for pregnancy outcomes in fresh GnRH antagonist ICSI cycles.
A retrospective cohort study conducted in a university-affiliated fertilization center between January 2017 and April 2019.
The study included women who underwent their first- or second-ranked GnRH antagonist ICSI cycles with day-3 embryo transfer. P/E2 ratio was calculated as (P [ng/mL] × 1000)/E2 (pg/mL). Cutoff values of ≥1.5 ng/ml for high P (HP) and ≥0.55 for HP/E2 ratio were chosen based on the literature.
A receiver operating curve was performed to detect the predictability of serum P/E2 and P for the ongoing pregnancy rate. First, patients were divided according to either P level (low < 1.5 ng/mL and HP ≥1.5 ng/mL) or P/E2 ratio (low P/E2 <0.55 and HP/E2 ≥ 0.55). Patients were further divided into four subgroups: (Group A: HP and HP/E2 ratio, Group B: low P and low P/E2 ratio, Group C: HP only, and Group D: HP/E2 only). A multivariate regression analysis models were used to account for the effect of the cycle confounders on the likelihood of pregnancy.
A total of 402 ICSI cycles were analyzed. The area under the curve was 0.67 and 0.59 for P/E2 and P, respectively. P/E2 showed a significant association with ongoing pregnancy (adjusted odds ratios [aOR]: 0.409, 95% confidence interval [CI] 0.222-0.753, = 0.004) while HP revealed no significant predictive value (aOR: 0.542, 95% CI 0.284-1.036, = 0.064) after the multivariate analysis.
P elevation may not present as an independent predictor for cycle outcomes. P/E2 ratio has a better prognostic value than alone in predicting pregnancy of GnRH antagonist cycles.
提出了几个参数来预测过早黄素化对卵胞浆内单精子注射（ICSI）结局的影响，如游离孕酮（P）水平、孕酮与卵母细胞比值以及孕酮/雌二醇比值（P/E2）。
本研究旨在比较新鲜GnRH拮抗剂ICSI周期中排卵触发日的P/E2比值和游离P水平对妊娠结局的预测价值。
2017年1月至2019年4月在一所大学附属的受精中心进行的一项回顾性队列研究。
该研究纳入了接受首次或第二次GnRH拮抗剂ICSI周期并在第3天进行胚胎移植的女性。P/E2比值计算为（P[ng/mL]×1000）/E2（pg/mL）。根据文献选择高P（HP）的临界值≥1.5 ng/ml和HP/E2比值的临界值≥0.55。
绘制受试者工作特征曲线以检测血清P/E2和P对持续妊娠率的预测能力。首先，根据P水平（低P<1.5 ng/mL和高P≥1.5 ng/mL）或P/E2比值（低P/E2<0.55和高P/E2≥0.55）对患者进行分组。患者进一步分为四个亚组：（A组：高P和高P/E2比值，B组：低P和低P/E2比值，C组：仅高P，D组：仅高P/E2）。使用多因素回归分析模型来解释周期混杂因素对妊娠可能性的影响。
共分析了402个ICSI周期。P/E2和P的曲线下面积分别为0.67和0.59。多因素分析后，P/E2与持续妊娠显著相关（调整后的优势比[aOR]：0.409，95%置信区间[CI]0.222 - 0.753，P = 0.004），而高P未显示出显著的预测价值（aOR：0.542，95%CI 0.284 - 1.036，P = 0.064）。
P升高可能不是周期结局的独立预测指标。在预测GnRH拮抗剂周期的妊娠方面，P/E2比值比单独的P具有更好的预后价值。
