Burns W N, Witz C A, Klein N A, Silverberg K M, Schenken R S
Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio 78284-7836.
J Assist Reprod Genet. 1994 Jan;11(1):17-23. doi: 10.1007/BF02213692.
In gonadotropin-releasing hormone analogue-pretreated in vitro fertilization-embryo transfer cycles, pregnancy rates are inversely related to serum progesterone levels on the day of administration of human chorionic gonadotropin. The relationship of the progesterone concentration on other days in the periovulatory period to pregnancy rates in such cycles is little studied. We therefore retrospectively analyzed the relationship between progesterone concentrations on the day after human chorionic gonadotropin and pregnancy in 114 cycles, 28 and 23 of which produced clinical and ongoing/delivered pregnancies, respectively. To assess the effect of the extent of follicular luteinization on success, we also studied the relationship between the progesterone concentration per oocyte retrieved and pregnancy for the day of and day after human chorionic gonadotropin.
Progesterone concentrations on the day after human chorionic gonadotropin were inversely associated with clinical pregnancy by multiple logistic regression analysis (P < 0.05). Progesterone/oocyte ratios were inversely associated with clinical pregnancy (P < 0.05) and ongoing/delivered pregnancy (P < 0.02) for both the day of and the day after human chorionic gonadotropin.
The study results extend the window of time during which elevated progesterone concentration is associated with poor outcome to at least 2 days. This finding is consistent with hypothetical mechanisms attributing the link between progesterone concentration and outcome to either endometrial or follicle/oocyte events. The association of lack of follicular luteinization (low progesterone per oocyte ratios) and favorable outcome suggests a predominant effect of progesterone on follicle/oocyte quality. Further studies are needed to clarify the mechanisms underlying the association between progesterone and in vitro fertilization-embryo transfer outcome.
在促性腺激素释放激素类似物预处理的体外受精 - 胚胎移植周期中，妊娠率与人绒毛膜促性腺激素给药当天的血清孕酮水平呈负相关。排卵期其他日子的孕酮浓度与此类周期妊娠率之间的关系研究较少。因此，我们回顾性分析了114个周期中人绒毛膜促性腺激素注射后一天的孕酮浓度与妊娠之间的关系，其中分别有28个和23个周期产生了临床妊娠和持续妊娠/分娩。为了评估卵泡黄素化程度对成功率的影响，我们还研究了人绒毛膜促性腺激素注射当天及之后每枚回收卵母细胞的孕酮浓度与妊娠之间的关系。
通过多因素逻辑回归分析，人绒毛膜促性腺激素注射后一天的孕酮浓度与临床妊娠呈负相关（P < 0.05）。人绒毛膜促性腺激素注射当天及之后，孕酮/卵母细胞比值与临床妊娠（P < 0.05）和持续妊娠/分娩（P < 0.02）均呈负相关。
研究结果将孕酮浓度升高与不良结局相关的时间窗口延长至至少2天。这一发现与将孕酮浓度和结局之间的联系归因于子宫内膜或卵泡/卵母细胞事件的假设机制一致。卵泡未黄素化（低孕酮/卵母细胞比值）与良好结局之间的关联表明孕酮对卵泡/卵母细胞质量有主要影响。需要进一步研究以阐明孕酮与体外受精 - 胚胎移植结局之间关联的潜在机制。
