Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
Clinics (Sao Paulo). 2024 Oct 9;79:100511. doi: 10.1016/j.clinsp.2024.100511. eCollection 2024.
Studies regarding serum Progesterone (P4) concentration and Clinical Pregnancy Rates (CPR) in fresh Embryo Transfer (ET) after Controlled Ovarian Stimulation Cycles (COS) remain inconclusive. To find a P4 cutoff point on fresh ET day associated with higher CPR, and to identify predictive factors of CPR and P4, the authors conducted a prospective cohort of 106 patients who underwent COS at a public IVF center. The luteal phase was supported with vaginal micronized progesterone (200 mg, 8/8h), beginning on oocyte retrieval day. The primary outcome was CPR beyond the 8 week of pregnancy. A ROC curve was constructed to identify the best cutoff point correlated with higher CPR. Multivariate analysis evaluated predictive variables of CPR and P4 concentration. P4 levels showed no significant differences between pregnant and non-pregnant patients (67.12 ± 31.1 ng/mL vs. 64.17 ± 61.76, p = 0.7465). The cutoff point correlated with higher CPR was P4 ≥ 28.9 ng/mL (AUC 0.5654). Women's age (OR = 0.878; 95 % CI 0.774-0.995) and top-quality embryo transfer (OR = 2.89; 95 % CI 1.148-7.316) were associated with CPR. Women's age ≥ 40 years (OR = 0.0956; 95 % CI 0.0156-0.5851), poor response to COS (OR = 0.0964; 95 % CI 0.0155-0.5966), and follicles ≥ 10 mm (OR = 1.465; 95 % CI 1.013-2.117) were associated with the cutoff point. As the ROC curve was unsatisfactory, P4 ≥ 28.9 ng/mL should not be used to infer gestational success. In fresh ET, P4 concentration may merely reflect a woman's age and individual response to COS rather than being a reliable CPR predictor.
关于控制性卵巢刺激周期（COS）后新鲜胚胎移植（ET）中血清孕激素（P4）浓度与临床妊娠率（CPR）的研究结果仍不一致。为了找到与更高 CPR 相关的新鲜 ET 日 P4 截断值，并确定 CPR 和 P4 的预测因素，作者对在一家公立 IVF 中心接受 COS 的 106 名患者进行了前瞻性队列研究。黄体期采用阴道微粒化黄体酮（200mg，8/8h）支持，从取卵日开始。主要结局是妊娠 8 周以上的 CPR。构建 ROC 曲线以确定与更高 CPR 相关的最佳截断值。多变量分析评估了 CPR 和 P4 浓度的预测变量。怀孕患者和未怀孕患者的 P4 水平无显著差异（67.12 ± 31.1ng/mL 比 64.17 ± 61.76，p = 0.7465）。与更高 CPR 相关的截断值为 P4≥28.9ng/mL（AUC 0.5654）。患者年龄（OR=0.878；95%CI 0.774-0.995）和优质胚胎移植（OR=2.89；95%CI 1.148-7.316）与 CPR 相关。患者年龄≥40 岁（OR=0.0956；95%CI 0.0156-0.5851）、COS 反应不良（OR=0.0964；95%CI 0.0155-0.5966）和卵泡≥10mm（OR=1.465；95%CI 1.013-2.117）与截断值相关。由于 ROC 曲线不理想，因此 P4≥28.9ng/mL 不应用于推断妊娠成功。在新鲜 ET 中，P4 浓度可能仅反映女性的年龄和对 COS 的个体反应，而不是可靠的 CPR 预测因素。
