Department of Obstetrics & Gynecology, Northwell Health Fertility, Northwell Health and Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, 11030, USA.
Department of Obstetrics & Gynecology, Center for Infertility and Reproductive Surgery, Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
J Assist Reprod Genet. 2022 Jul;39(7):1611-1618. doi: 10.1007/s10815-022-02521-0. Epub 2022 May 18.
Supraphysiologic serum estradiol levels may negatively impact the likelihood of conception and live birth following IVF. The purpose of this study is to determine if there is an association between serum estradiol level on the day of progesterone start and clinical outcomes following programmed frozen blastocyst transfer cycles utilizing oral estradiol.
This is a retrospective cohort study at an academic fertility center analyzing 363 patients who underwent their first autologous single (SET) or double frozen embryo transfer (DET) utilizing oral estradiol and resulting in blastocyst transfer from June 1, 2012, to June 30, 2018. Main outcome measures included implantation, clinical pregnancy, live birth, and miscarriage rates. Cycles were stratified by quartile of serum estradiol on the day of progesterone start and separately analyzed for SET cycles only. Poisson and Log binomial regression were used to calculate relative risks (RR) with 95% confidence intervals (CI) for implantation, clinical pregnancy, live birth, and miscarriage with adjustments made for age and BMI.
Cycles with the highest quartile of estradiol (mean 528 pg/mL) were associated with lower risks of implantation (RR 0.66, CI 0.50-0.86), ongoing pregnancy (RR 0.66, CI 0.49-0.88), and live birth (RR 0.70, CI 0.52-0.94) compared with those with the lowest estradiol quartile (mean 212 pg/mL). Similar findings were seen for analyses limited to SETs. There was no significant difference in miscarriage rate or endometrial thickness between groups.
High levels of serum estradiol on the day of progesterone start may be detrimental to implantation, pregnancy, and live birth following frozen blastocyst transfer.
超生理血清雌二醇水平可能会降低体外受精（IVF）后妊娠和活产的可能性。本研究旨在确定在利用口服雌二醇进行程序化冷冻囊胚移植周期中，孕激素起始日血清雌二醇水平与临床结局之间是否存在关联。
这是一项在学术生育中心进行的回顾性队列研究，分析了 363 名患者的资料，这些患者于 2012 年 6 月 1 日至 2018 年 6 月 30 日期间进行了第一次自体单（SET）或双冷冻胚胎移植（DET），并利用口服雌二醇进行了囊胚移植。主要结局指标包括着床率、临床妊娠率、活产率和流产率。根据孕激素起始日血清雌二醇的四分位进行分组，并仅对 SET 周期进行单独分析。采用泊松和对数二项式回归计算调整年龄和 BMI 后着床、临床妊娠、活产和流产的相对风险（RR）及其 95%置信区间（CI）。
雌二醇最高四分位数（平均 528 pg/mL）的周期与着床率（RR 0.66，95%CI 0.50-0.86）、持续妊娠率（RR 0.66，95%CI 0.49-0.88）和活产率（RR 0.70，95%CI 0.52-0.94）降低相关，与雌二醇最低四分位数（平均 212 pg/mL）的周期相比。对于仅限于 SET 的分析也观察到类似的结果。两组间流产率或子宫内膜厚度无显著差异。
孕激素起始日血清雌二醇水平升高可能对冷冻囊胚移植后的着床、妊娠和活产不利。
