First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, Shandong, China.
Front Endocrinol (Lausanne). 2024 Sep 24;15:1411106. doi: 10.3389/fendo.2024.1411106. eCollection 2024.
The optimal outcome of assisted reproductive technology is a successful live birth after fresh embryo transfer. However, the success pregnancy rate of fresh embryo transfer cycle in antagonist protocol is lower than that observed in other protocols. Despite the use of antagonists (GnRH-ant), the incidence of luteinizing hormone surge and elevated progesterone levels remain at approximately 5%-38%. Progesterone is widely recognized to exert adverse effects on fresh embryo transfer outcomes. This study aimed to investigate the impact of luteinizing hormone surge and progesterone levels on live birth rate following fresh embryo transfer and explore appropriate progesterone thresholds to enhance pregnancy outcomes.
This retrospective cohort study included a total of 1,177 antagonist protocol cycles with fresh embryo transfer. The patients were divided into four groups based on the presence of premature LH surge and progesterone level on trigger day>1.5ng/ml. Then, the relationship between the variables and the pregnancy outcome was analyzed and compared in each group.
The transient rise of luteinizing hormone did not impact pregnancy outcomes (P=0.345; P=0.3; P=0.787), in contrast to progesterone levels on the day of hCG administration (P=0.047*; P=0.015*; P=0.021*). In cases with luteinizing hormone surge, elevated progesterone levels were correlated with higher antral follicle count (AFC), and as progesterone levels increased, a greater quantity of oocytes and embryos were obtained. However, there was no statistically significant difference in pregnancy outcomes. In cases without luteinizing hormone surge, elevated progesterone levels led to significantly poorer pregnancy outcomes. Furthermore, the curve-fitting and threshold-effect analysis revealed a notable decline in live birth rates when progesterone exceeded or equaled 1.10ng/ml (OR, 0.25; 95% CI, 0.09-0.66; P = 0.005*).
The GnRH-ant dosage addition should be carefully selected in flexible antagonist protocols. The presence of elevated progesterone levels may be associated with improved embryo quality when luteinizing hormone surge occurred. In the absence of a luteinizing hormone surge, progesterone levels showed a larger impact on the pregnancy outcome, and fresh embryo transfer should not be performed if the progesterone level on the day of hCG administration is higher than 1.10ng/ml.
辅助生殖技术的最佳结果是新鲜胚胎移植后成功活产。然而，拮抗剂方案中新鲜胚胎移植周期的妊娠成功率低于其他方案。尽管使用了拮抗剂（GnRH 拮抗剂），但黄体生成素峰和孕酮水平升高的发生率仍约为 5%-38%。孕酮被广泛认为对新鲜胚胎移植结局有不良影响。本研究旨在探讨黄体生成素峰和孕酮水平对新鲜胚胎移植后活产率的影响，并探讨合适的孕酮阈值以提高妊娠结局。
本回顾性队列研究共纳入 1177 例新鲜胚胎移植拮抗剂方案周期。根据触发日黄体生成素过早升高和孕酮水平>1.5ng/ml，将患者分为四组。然后分析比较各组中各变量与妊娠结局的关系。
黄体生成素的短暂升高并未影响妊娠结局（P=0.345；P=0.3；P=0.787），而 hCG 给药日孕酮水平则有影响（P=0.047*；P=0.015*；P=0.021*）。在黄体生成素升高的情况下，孕酮水平升高与窦卵泡计数（AFC）增加相关，并且随着孕酮水平的升高，获得的卵母细胞和胚胎数量增加。然而，妊娠结局无统计学差异。在黄体生成素无升高的情况下，孕酮水平升高导致妊娠结局明显变差。此外，曲线拟合和阈值效应分析显示，当孕酮超过或等于 1.10ng/ml 时，活产率显著下降（OR，0.25；95%CI，0.09-0.66；P=0.005*）。
在灵活的拮抗剂方案中，应仔细选择 GnRH 拮抗剂的剂量。当黄体生成素升高时，孕酮水平升高可能与胚胎质量改善相关。在无黄体生成素升高的情况下，孕酮水平对妊娠结局的影响更大，如果 hCG 给药日孕酮水平高于 1.10ng/ml，则不应进行新鲜胚胎移植。
