A decrease in serum estradiol levels after human chorionic gonadotrophin administration predicts significantly lower clinical pregnancy and live birth rates in in vitro fertilization cycles †
A decrease in serum estradiol levels after human chorionic gonadotrophin administration predicts significantly lower clinical pregnancy and live birth rates in in vitro fertilization cycles †
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DOI：
10.1093/humrep/des216
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发表时间：
2012-09-01
影响因子：
6.1
通讯作者：
Dokras, A.
中科院分区：
文献类型：
--
作者：
Kondapalli, L. A.;Molinaro, T. A.;Dokras, A.
虽然密切观察血清雌二醇（E2）水平仍然是评估控制性卵巢刺激临床反应的主要手段，但hCG给药后E2水平的任何变化的预后价值仍不清楚。本研究的目的是评估hCG给药后血清E2反应与新鲜IVF周期临床妊娠率和活产率之间的关系，我们对1999年至2008年接受首次IVF周期的2145岁女性进行了回顾性队列研究。我们比较了hCG后血清E2水平与hCG触发当天的值。IVF周期按hCG后E2反应分层，并进行适当的参数和非参数统计。临床宫内妊娠和活产是关注的主要结局。在1712个IVF周期中，1065个周期显示hCG后E2水平升高10（A组），525个周期显示hCG后E2水平平稳（10，B组），122个周期显示hCG后E2水平降低10（C组）。虽然各组hCG当天的E2水平相似，但C组有更多的卵巢储备减少的患者，需要更高的促性腺激素剂量，植入率最低。在校正年龄、总促性腺激素剂量、不孕症诊断、卵母细胞数量和移植胚胎数量后，hCG后E2下降（C组）与临床妊娠[校正比值比（aOR）：0.53; 95置信区间（CI）：0.33 - 0.84，P 0.007]和活产之间的相关性（aOR：0.40; 95 CI：0.220.71，P0.002）有显著性差异。我们还发现E2平台（B组）与临床妊娠有显著相关性（aOR：0.73; 95 CI：0.57 ± 0.94，P0.013）和活产（aOR：0.74; 95 CI：0.560.97，P 0.032）。在我们的研究中，hCG给药后E2水平的降低与临床妊娠率和活产率的降低相关。同样，hCG后E2平台期（10）使临床妊娠率和活产率降低25。我们的研究表明，hCG后E2水平的变化是另一个参数，临床医生可以使用它来指导患者在取卵前使用辅助生殖技术成功的可能性。
Although close observation of serum estradiol (E2) levels remains a mainstay of assessing clinical response to controlled ovarian stimulation, the prognostic value of any change in E2 levels after administration of hCG remains unclear. The objective of this study is to evaluate the relationship between serum E2 response after hCG administration and the clinical pregnancy and live birth rates in fresh IVF cycles.We conducted a retrospective cohort study of women aged 2145 years undergoing their first IVF cycle from 1999 to 2008 at a single practice. We compared the post-hCG serum E2 level with values on the day of hCG trigger. IVF cycles were stratified by post-hCG E2 response and appropriate parametric and non-parametric statistics were performed. Clinical intrauterine pregnancy and live births were the primary outcomes of interest. Multivariable logistic regression models were created to identify predictive factors associated with outcomes while adjusting for potential confounders.Among the 1712 IVF cycles, 1065 exhibited a 10 increase (Group A), 525 had a plateau (10, Group B) and 122 showed a 10 decrease (Group C) in post-hCG E2 levels. While the E2 levels on the day of hCG were similar across groups, Group C had more patients with diminished ovarian reserve, required higher gonadotrophin doses and had the lowest implantation rates. After adjusting for age, total gonadotrophin dose, infertility diagnosis, number of oocytes and number of transferred embryos, the associations between post-hCG E2 decline (Group C) and clinical pregnancy [adjusted odds ratio (aOR): 0.53; 95 confidence interval (CI): 0.330.84, P 0.007] and live birth (aOR: 0.40; 95 CI: 0.220.71, P 0.002) were significant. We also found significant associations between E2 plateau (Group B) and clinical pregnancy (aOR: 0.73; 95 CI: 0.570.94, P 0.013) and live birth (aOR: 0.74; 95 CI: 0.560.97, P 0.032) when adjusting for the same factors.In our study, 10 decrease in E2 levels after hCG administration was associated with 4050 reduction in clinical pregnancy and live birth rates. Similarly, post-hCG E2 plateau (10) lowered the clinical pregnancy and live birth rates by 25. Our study suggests that the change in the post-hCG E2 level is another parameter that can be used by clinicians to counsel patients regarding their likelihood of success with assisted reproductive technologies prior to oocyte retrieval.