Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona 08028, Spain; Autonomous University of Barcelona, Cerdanyola del Vallès 08193, Spain.
IVI-RMA Lisboa, Lisbon 1800-282, Portugal.
Reprod Biomed Online. 2021 Dec;43(6):1063-1069. doi: 10.1016/j.rbmo.2021.07.019. Epub 2021 Aug 6.
Does late-follicular phase progesterone elevation have a deleterious effect on embryo euploidy, blastocyst formation rate and cumulative live birth rates (CLBR)?
A multicentre retrospective cross-sectional study including infertile patients aged 18-40 years who underwent ovarian stimulation in a gonadotrophin-releasing hormone antagonist protocol and preimplantation genetic testing for aneuploidies (PGT-A) followed by a freeze-all strategy and euploid embryo transfer between August 2017 and December 2019. The sample was stratified according to the progesterone concentrations on the day of trigger: normal (≤1.50 ng/ml) and high (>1.50 ng/ml). Moreover, sensitivity analyses were performed to determine whether different conclusions would have been drawn if different cut-offs had been adopted. The primary outcome was the embryo euploidy rate. Secondary outcomes were the blastocyst formation rate, the number of euploid blastocysts and CLBR.
Overall 1495 intracytoplasmic sperm injection PGT-A cycles were analysed. Late-follicular phase progesterone elevation was associated with significantly higher late-follicular oestradiol concentrations (2847.56 ± 1091.10 versus 2240.94 ± 996.37 pg/ml, P < 0.001) and significantly more oocytes retrieved (17.67 ± 8.86 versus 12.70 ± 7.00, P < 0.001). The number of euploid embryos was significantly higher in the progesterone elevation group (2.32 ± 1.74 versus 1.86 ± 1.42, P = 0.001), whereas the blastocyst formation rate (47.1% [43.7-50.5%] versus 51.0% [49.7-52.4%]), the embryo euploidy rate (48.3% [44.9-51.7%] versus 49.1% [47.7-50.6%], the live birth rate in the first frozen embryo transfer (34.1% versus 31.1%, P = 0.427) and CLBR (38.9% versus 37.0%, P = 0.637) were not significantly different between the two groups.
Euploidy rate and CLBR do not significantly differ among PGT-A cycles with and without late-follicular progesterone elevation in a freeze-all approach.
黄体期晚期孕酮升高是否对胚胎整倍体、囊胚形成率和累积活产率（CLBR）有不良影响？
这是一项多中心回顾性横断面研究，纳入了 2017 年 8 月至 2019 年 12 月期间接受促性腺激素释放激素拮抗剂方案卵巢刺激、植入前遗传学检测（PGT-A）和冷冻所有策略以及整倍体胚胎移植的 18-40 岁不孕患者。根据扳机日孕酮浓度将样本分层：正常（≤1.50ng/ml）和高（>1.50ng/ml）。此外，还进行了敏感性分析，以确定采用不同的截止值是否会得出不同的结论。主要结局是胚胎整倍体率。次要结局是囊胚形成率、整倍体囊胚数量和 CLBR。
共分析了 1495 例胞浆内精子注射 PGT-A 周期。黄体期晚期孕酮升高与黄体期晚期雌二醇浓度显著升高相关（2847.56±1091.10 与 2240.94±996.37pg/ml，P<0.001），并且取卵数也显著增加（17.67±8.86 与 12.70±7.00，P<0.001）。孕酮升高组的整倍体胚胎数量明显更高（2.32±1.74 与 1.86±1.42，P=0.001），而囊胚形成率（47.1%[43.7-50.5%]与 51.0%[49.7-52.4%]）、胚胎整倍体率（48.3%[44.9-51.7%]与 49.1%[47.7-50.6%]）、首次冷冻胚胎移植的活产率（34.1%与 31.1%，P=0.427）和 CLBR（38.9%与 37.0%，P=0.637）在两组之间无显著差异。
在冷冻所有方法中，PGT-A 周期中黄体期晚期孕酮升高与不升高对胚胎整倍体率和 CLBR 无显著影响。
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