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| 卵泡期长效长方案扳机日孕酮水平对胚胎质量及妊娠结局的影响 |
| Effect of progesterone level on day of hCG administration on embryo quality and pregnancy outcomes of cycles with long-acting GnRH agonist protocol in follicular phase |
| 投稿时间：2021-07-07 |
| DOI：10.3969/j.issn.1000-0399.2022.05.010 |
| 中文关键词: 卵泡期长效长方案 体外受精-胚胎移植 孕酮 妊娠结局 |
| 英文关键词: Long-acting GnRH agonist protocol in follicular phase In vitro fertilization and embryo transfer Progesterone Pregnancy outcome |
| 基金项目:合肥市医学重点专科建设计划资助项目[合卫科教(2019)160号],安徽省重点研究与开发计划项目(项目编号:1704a0802171) |
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| 中文摘要: |
| 目的 探讨卵泡期长效长方案中扳机日血清孕酮水平对胚胎质量、妊娠结局的影响,探索导致扳机日血清孕酮水平升高的影响因素。方法 对安徽医科大学附属妇幼保健院生殖医学中心511例行卵泡期长效长方案降调节促排卵方案助孕周期资料进行回顾性分析,以扳机日血清孕酮1.5 ng/mL为界值分为A组(孕酮 ≥ 1.5 ng/mL)与B组(孕酮<1.5 ng/mL),比较A、B组获卵数及胚胎质量的差异;再将511例周期资料中所有新鲜胚胎移植周期根据孕酮水平分为A1组(孕酮 ≥ 1.5 ng/mL)与B1组(孕酮<1.5 ng/mL),比较两组妊娠结局差异;使用二元logistic回归分析探讨影响扳机日血清孕酮升高的相关因素,应用受试者工作特征(ROC)曲线分析危险因素的预测价值。结果 A、B组间正常受精率、优质胚胎率差异无统计学意义(P>0.05);A组的获卵数(14.11±5.47)枚、成熟卵子数(11.77±4.79)枚、正常卵子受精数[(9.35±4.70)个]高于B组获卵数(9.46±4.31)枚、成熟卵子数(7.81±3.94)枚、正常卵子受精数[(6.28±3.44)个],差异有统计学意义(P<0.05)。A1组胚胎着床率(21.21%)、临床妊娠率(31.25%)均低于B1组胚胎着床率(42.00%)、临床妊娠率(57.89%),差异有统计学意义(P<0.05)。身体质量指数(OR=0.873,95%CI:0.808~0.942)和获卵数(OR=1.226,95%CI:1.169~1.286)均是扳机日血清孕酮升高的影响因素(P<0.05)。ROC曲线分析显示,身体质量指数可用于诊断扳机日血清孕酮水平升高,其曲线下面积为0.606(95%CI:0.557~0.656),约登指数最大值所对应的身体质量指数值为21.38 kg/m2,该值的敏感度为58.9%,特异度为58.5%。结论 扳机日血清孕酮升高会降低着床率及临床妊娠率,但不影响胚胎质量。身体质量指数和获卵数是扳机日血清孕酮水平升高的影响因素。 |
| 英文摘要: |
| Objective To investigate the effect of serum progesterone(P) level on trigger day on embryo quality and pregnancy outcomes of cycles with long-acting GnRH agonist protocol in ollicular phase, and to investigatethe factors causing progesterone elevation on trigger day.Methods A total of 511 cycles in Reproductive Medicine Center, Maternal and Child Health Hospital Affiliated toAnhui Medical Universitywith long-acting GnRH agonist protocol in follicular phase were analyzed.All cycles were divided into group A (progesterone ≥ 1.5 ng/mL) and group B (progesterone<1.5 ng/mL). The number of oocytes retrieved and the quality of embryos between groups A and B were compared.All fresh embryo transfer cycles in 511 cycles were divided into group A1(progesterone ≥ 1.5 ng/mL) and group B1(progesterone<1.5 ng/mL).The pregnancy outcomes between groups A1 and B1were compared.Multivariate logistic regression was used to analyze the influencing factors in elevated serum progesterone levels on trigger day. Receiver operating characteristic(ROC) curve was used to analyze the predictive value of risk factors.Results There was no significant difference in fertilization rate, high-quality embryo ratebetween groups A and B(P>0.05). The number of oocytes retrieved(14.11±5.47),mature eggs (11.77±4.79) and normal fertilized eggs(9.35±4.70) in group A was higher than the number of oocytes retrieved (9.46±4.31),mature eggs(7.81±3.94) and normal fertilized eggs(6.28±3.44)in group B (P<0.05). The embryo implantation rate(21.21%), clinical pregnancy rate(31.25%) in group A1 was higher than the embryo implantation rate(42.00%), clinical pregnancy rate(57.89%)in group B1,and the difference was statistically significant(P<0.05).The number of oocytes retrieved (OR=1.226,95%CI:1.169~1.286) and body mass index(BMI)(OR=0.873,95%CI:0.808~0.942) were the influencing factors for the rise of progesterone level on trigger day.ROC showed that BMI could be used to diagnose elevated serum progesterone levels on trigger days. The area under the curve was 0.606, 95%CI:0.557-0.656, the BMI value corresponding to the maximum value of Youden index was 21.38 kg/m2, the sensitivity of this value was 58.9%, and the specificity was 58.5%.Conclusions Progesterone elevation on trigger day has no influence on embryo quality, but high progesterone level reduces embryo implantation rate and clinical pregnancy rate.BMI and oocytes retrieved are influencing factors for elevated progesterone levels on the trigger day. |
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