血清孕酮和抑制素A在监测自然周期体外受精-胚胎移植中的应用。

The utility of serum progesterone and inhibin A for monitoring natural-cycle IVF-ET.

作者信息

Lindheim S R, Chang P L, Vidali A, Ferin M, Sauer M V

机构信息

Department of Obstetrics and Gynecology, Columbia Presbyterian Medical Center, College of Physicians & Surgeons, Columbia University, New York, New York 10032, USA.

出版信息

J Assist Reprod Genet. 1998 Oct;15(9):538-41. doi: 10.1023/a:1022530103330.

DOI:10.1023/a:1022530103330

PMID:9822981

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3454917/

Abstract

PURPOSE

Our purpose was to assess the value of monitoring serum P and inhibin A to determine how values might improve the clinical monitoring of natural cycle in vitro fertilization (IVF)-embryo transfer (ET) patients.

METHODS

All patients (n = 26) who underwent natural-cycle IVF-ET (n = 35) were analyzed. Groups were evaluated according to patients who had a spontaneous luteinizing hormone (LH) surge (group I) and women receiving human chorionic gonadotropin (hCG) who underwent subsequent oocyte aspiration (group II). Group II was further evaluated according to women who did (n = 10) and did not (n = 7) have an ET. All cycles were evaluated with serial transvaginal ultrasonography and serum estradiol, progesterone, and inhibin A. When follicle maturity was achieved, hCG, 10,000 IU, was administered intramuscularly if a LH surge was not detected. Transvaginal ultrasound-guided aspiration was performed 34-36 hr after hCG administration followed by a 48-hr transcervical ET.

RESULTS

No differences were seen in cycles the day prior to (d-1) and the day of a spontaneous LH surge, (n = 18) or hCG (d-0)(n = 17) in group I or group II with respect to lead follicular diameter (d-1, 15.3 +/- 0.6 vs. 14.2 +/- 0.9 mm; d-0, 17.4 +/- 0.8 vs. 17.8 +/- 0.6 mm) and serum estradiol (d-1, 148 +/- 15 vs. 150 +/- 15 pg/ml; d-0, 218 +/- 15 vs. 199 +/- 16 pg/ml), respectively. However, serum progesterone was significantly elevated in group I compared with group II on d-1 (0.82 +/- 0.6 vs. 0.48 +/- 0.04 ng/ml; P < 0.05) and d-0 (1.1 +/- 0.12 vs. 0.63 +/- 0.08 ng/ml; P < 0.05). Inhibin A was significantly greater on d-1 in group I (24 +/- 2.5 vs. 15 +/- 2.2 pg/ml; P < 0.05). In group II, cycles that resulted in an ET (n = 10) compared with group II cycles that did not (n = 7) revealed a significant difference in serum progesterone (0.51 +/- 0.05 vs. 0.7 +/- 0.07 ng/ml; P < 0.05) and inhibin A (15 +/- 2.5 vs. 37.3 +/- 5 pg/ml; P < 0.05) the day of hCG.

CONCLUSIONS

The possible application of serum progesterone and inhibin A in managing natural-cycle IVF-ET is suggested. These assays may predict women who should be set up for egg retrieval, while cancelling others in spite of the absence of an LH surge.

摘要

目的

我们的目的是评估监测血清P和抑制素A的价值，以确定这些指标如何改善自然周期体外受精（IVF）-胚胎移植（ET）患者的临床监测。

方法

对所有接受自然周期IVF-ET（n = 35）的患者（n = 26）进行分析。根据出现自发促黄体生成素（LH）峰的患者（I组）和接受人绒毛膜促性腺激素（hCG）并随后进行卵母细胞抽吸的女性（II组）进行分组评估。II组根据进行了ET的女性（n = 10）和未进行ET的女性（n = 7）进一步评估。所有周期均通过连续经阴道超声检查以及血清雌二醇、孕酮和抑制素A进行评估。当卵泡成熟时，如果未检测到LH峰，则肌肉注射10,000 IU的hCG。在hCG给药后34 - 36小时进行经阴道超声引导下抽吸，随后进行48小时的经宫颈ET。

结果

在I组或II组中，自发LH峰前一天（d - 1）和当天（n = 18）或hCG当天（d - 0）（n = 17）的周期，在主导卵泡直径（d - 1，15.3±0.6 vs. 14.2±0.9 mm；d - 0，17.4±0.8 vs. 17.8±0.6 mm）和血清雌二醇（d - 1，148±15 vs. 150±15 pg/ml；d - 0，218±15 vs. 199±16 pg/ml）方面均未观察到差异。然而，I组血清孕酮在d - 1（0.82±0.6 vs. 0.48±0.04 ng/ml；P < 0.05）和d - 0（1.1±0.12 vs. 0.63±0.08 ng/ml；P < 0.05）时显著高于II组。I组d - 1时抑制素A显著更高（24±2.5 vs. 15±2.2 pg/ml；P < 0.05）。在II组中，进行了ET的周期（n = 10）与未进行ET的周期（n = 7）相比，hCG当天血清孕酮（0.51±0.05 vs. 0.7±0.07 ng/ml；P < 0.05）和抑制素A（15±2.5 vs. 37.3±5 pg/ml；P < 0.05）存在显著差异。