基于激素详细早黄体期轨迹的体外受精结局：一项前瞻性队列研究。

In vitro fertilization outcome based on the detailed early luteal phase trajectory of hormones: a prospective cohort study.

机构信息

Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam.

IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam.

出版信息

Reprod Biol Endocrinol. 2024 May 20;22(1):56. doi: 10.1186/s12958-024-01229-3.

DOI:10.1186/s12958-024-01229-3

PMID:38769552

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11103990/

Abstract

BACKGROUND

Ovarian stimulation and the use of human chorionic gonadotropin (hCG) for triggering oocyte maturation in women undergoing in vitro fertilisation (IVF) introduces several differences in luteal phase hormone levels compared with natural cycles that may negatively impact on endometrial receptivity and pregnancy rates after fresh embryo transfer. Exogenous luteal phase support is given to overcome these issues. The suitability of a pragmatic approach to luteal phase support is not known due to a lack of data on early phase luteal hormone levels and their association with fertility outcomes during IVF with fresh embryo transfer. This study determined early luteal phase profiles of serum progesterone, 17-hydroxyprogesterone and hCG, and associations between hormone levels/hormone level profile after hCG trigger and the live birth rate in women undergoing IVF with fresh embryo transfer.

METHODS

This prospective single center, cohort study was conducted in Vietnam from January 2021 to December 2022. Women aged 18-38 years with normal ovarian reserve and undergoing controlled ovarian stimulation using a gonadotropin-releasing hormone antagonist protocol were included. Serum hormone levels were determined before trigger, at 12, 24 and 36 h after hCG, and daily from 1 to 6 days after oocyte pick-up. Serum hormone level profiles were classified as lower or upper. The primary outcome was live birth rate based on early luteal phase hormone level profile.

RESULTS

Ninety-five women were enrolled. Live birth occurred in 19/69 women (27.5%) with a lower progesterone profile and 13/22 (59.1%) with an upper progesterone profile (risk ratio [RR] 2.15; 95% confidence interval [CI] 1.28-3.60), and in 6/31 (19.4%) versus 26/60 (43.3%) with a lower versus upper serum 17-hydroxyprogesterone profile (RR 2.24; 95% CI 1.03-4.86). Nearly 20% of women had peak progesterone concentration on or before day 3 after oocyte pick-up, and this was associated with significantly lower chances of having a life birth.

CONCLUSIONS

These data show the importance of proper corpus luteum function with sufficient progesterone/17-hydroxyprogesterone production for achievement of pregnancy and to maximize the chance of live birth during IVF.

TRIAL REGISTRATION

NCT04693624 ( www.

CLINICALTRIALS

gov ).

摘要

背景

在接受体外受精（IVF）的女性中，卵巢刺激和使用人绒毛膜促性腺激素（hCG）触发卵母细胞成熟会导致黄体期激素水平与自然周期存在一些差异，这可能会对新鲜胚胎移植后的子宫内膜容受性和妊娠率产生负面影响。为了解决这些问题，需要进行外源性黄体支持。由于缺乏关于早期黄体激素水平及其与新鲜胚胎移植后 IVF 生育结局的关系的数据，因此尚不清楚采用实用方法进行黄体支持的适宜性。本研究旨在确定接受新鲜胚胎移植的 IVF 女性的早期黄体期孕激素、17-羟孕酮和 hCG 水平，并探讨 hCG 触发后激素水平/激素水平曲线与活产率之间的关系。

方法

本前瞻性单中心队列研究于 2021 年 1 月至 2022 年 12 月在越南进行。纳入年龄在 18-38 岁之间、卵巢储备正常且接受促性腺激素释放激素拮抗剂方案进行控制性卵巢刺激的女性。在 hCG 触发前、触发后 12、24 和 36 小时以及取卵后 1-6 天，每天测定血清激素水平。根据早期黄体期激素水平曲线，将血清激素水平曲线分为低水平或高水平。主要结局是基于早期黄体期激素水平曲线的活产率。

结果

共纳入 95 名女性。19/69 名（27.5%）孕激素水平较低的女性和 13/22 名（59.1%）孕激素水平较高的女性发生活产（风险比 [RR] 2.15；95%置信区间 [CI] 1.28-3.60），6/31 名（19.4%）和 26/60 名（43.3%）血清 17-羟孕酮水平较低的女性和较高的女性发生活产（RR 2.24；95% CI 1.03-4.86）。近 20%的女性在取卵后第 3 天或之前达到了孕激素峰值浓度，这与活产率显著降低有关。