Kalakota Nischelle R, George Lea C, Morelli Sara S, Douglas Nataki C, Babwah Andy V
Department of Obstetrics, Gynecology and Reproductive Health, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ 07107, USA.
Center for Immunity and Inflammation, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ 07107, USA.
Cells. 2022 Apr 21;11(9):1405. doi: 10.3390/cells11091405.
Ovarian stimulation is an indispensable part of IVF and is employed to produce multiple ovarian follicles. In women who undergo ovarian stimulation with gonadotropins, supraphysiological levels of estradiol, as well as a premature rise in progesterone levels, can be seen on the day of hCG administration. These alterations in hormone levels are associated with reduced embryo implantation and pregnancy rates in IVF cycles with a fresh embryo transfer. This article aims to improve the reader's understanding of the effects of elevated progesterone levels on human endometrial receptivity and oocyte/embryo quality. Based on current clinical data, it appears that the premature rise in progesterone levels exerts minimal or no effects on oocyte/embryo quality, while advancing the histological development of the secretory endometrium and displacing the window of implantation. These clinical findings strongly suggest that reduced implantation and pregnancy rates are the result of a negatively affected endometrium rather than poor oocyte/embryo quality. Understanding the potential negative impact of elevated progesterone levels on the endometrium is crucial to improving implantation rates following a fresh embryo transfer. Clinical studies conducted over the past three decades, many of which have been reviewed here, have greatly advanced our knowledge in this important area.
卵巢刺激是体外受精不可或缺的一部分，用于产生多个卵巢卵泡。在接受促性腺激素卵巢刺激的女性中，在注射人绒毛膜促性腺激素（hCG）当天可观察到超生理水平的雌二醇以及孕酮水平过早升高。在进行新鲜胚胎移植的体外受精周期中，这些激素水平的变化与胚胎着床率和妊娠率降低有关。本文旨在增进读者对孕酮水平升高对人子宫内膜容受性和卵母细胞/胚胎质量影响的理解。根据目前的临床数据，孕酮水平过早升高似乎对卵母细胞/胚胎质量影响极小或无影响，而会使分泌期子宫内膜的组织学发育提前并使着床窗移位。这些临床发现强烈表明，着床率和妊娠率降低是子宫内膜受到负面影响的结果，而非卵母细胞/胚胎质量差。了解孕酮水平升高对子宫内膜的潜在负面影响对于提高新鲜胚胎移植后的着床率至关重要。过去三十年进行的临床研究，其中许多在此进行了综述，极大地推进了我们在这一重要领域的知识。
