The impact of peak estradiol during controlled ovarian stimulation on the cumulative live birth rate of IVF/ICSI in non-PCOS patients
The impact of peak estradiol during controlled ovarian stimulation on the cumulative live birth rate of IVF/ICSI in non-PCOS patients
复制标题
控制性卵巢刺激期间雌二醇峰值对非 PCOS 患者 IVF/ICSI 累积活产率的影响
DOI：
10.1007/s10815-019-01568-w
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发表时间：
2019-11-01
影响因子：
3.1
通讯作者：
Wang, Xiaohong
中科院分区：
文献类型：
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作者：
Zhang, Wanlin;Tian, Ying;Wang, Xiaohong
目的探讨卵巢储备正常的非pcos女性控制性卵巢过度刺激（COS）时E2峰值水平对累积活产率（cLBR）的影响。材料与方法纳入年龄在20 ~ 39岁的女性。捐赠者周期和从未经历过胚胎移植的患者被排除在外。采用多变量回归和光滑曲线拟合进行统计分析。结果共纳入1141例患者。平均年龄为30.0±3.7岁，基础AFC为16.8±6.7岁，E2峰值为3911.0±1302.9 pg/ml，取卵数为13.6±5.5岁。在队列总体人群中，cLBR、流产率和早产率分别为66.9%、7.4%和13.7%。多变量回归分析结果未能显示E2峰对cLBR的影响[OR (95%CI) 0.995 (0.982, 1.009)，P= 0.486]。平滑曲线拟合结果表明，当E2峰值低于2185 pg/ml时，随着E2峰值增加100 pg/ml， cLBR增加约12%。当E2峰值高于6136 pg/ml时，随着E2峰值增加100 pg/ml， cLBR降低约10%。结论hCG触发日E2峰值水平与cLBR呈节段性相关。在非多囊卵巢综合征患者中，采用以GnRH激动剂为主的刺激方案，在COS期间应有适当的E2峰值水平范围，以达到相对最佳的cLBR；然而，截止值必须在不同的中心变化。
ObjectiveThe study aimed to investigate the impact of the peak E2 level during controlled ovarian hyperstimulation (COS) on the cumulative live birth rate (cLBR) in non-PCOS women with normal ovarian reserve.Materials and methodsWomen between 20 and 39 years were included. Donor cycles and patients who never experienced embryo transfer were excluded. Multivariable regression and smooth curve fitting were applied for statistical analysis.ResultsA total of 1141 patients were included. The mean age, basal AFC, peak E2 level, and number of retrieved oocyte were 30.0 ± 3.7 years old, 16.8 ± 6.7, 3911.0 ± 1302.9 pg/ml, and 13.6 ± 5.5, respectively. In the overall population of the cohort, cLBR, miscarriage rate, and preterm birth rate were 66.9%, 7.4%, and 13.7%, respectively. The results of multivariable regression analysis failed to show the impact of peak E2 on the cLBR [OR (95%CI) 0.995 (0.982, 1.009),P= 0.486]. However, the result of smooth curve fitting indicated that when the peak E2 was lower than 2185 pg/ml, the cLBR increased about 12% with 100 pg/ml increasing of the peak E2. When the peak E2 was higher than 6136 pg/ml, the cLBR decreased about 10% with 100 pg/ml increasing of the peak E2.ConclusionWe concluded that the peak E2 level on hCG trigger day is associated with the cLBR in a segmental pattern. There should be an appropriate range of the peak E2 level during COS to achieve a relative best cLBR in non-PCOS patients using stimulating protocol mainly based on GnRH agonist; however, the cutoff value must vary in different centers.