Serum progesterone concentration on day of embryo transfer in donor oocyte cycles
Serum progesterone concentration on day of embryo transfer in donor oocyte cycles
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DOI：
10.1007/s10815-014-0199-y
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发表时间：
2014-05-01
影响因子：
3.1
通讯作者：
Racowsky, Catherine
中科院分区：
文献类型：
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作者：
Brady, Paula C.;Kaser, Daniel J.;Racowsky, Catherine
评估新鲜供体IVF/ICSI周期中胚胎移植（ET）当天血清孕酮(P)水平与妊娠率的关系。纳入2007年10月至2012年8月ET为第3天的新鲜供体周期（n = 229）。大多数周期（93%）使用促性腺激素释放激素（GnRH）激动剂；口服、阴道或经皮雌二醇用于子宫内膜启动，肌注P用于黄体支持（50-100 mg/天）。在ET测量受体P水平，如果每次临床实践P剂量< 20 ng/mL，则P剂量增加50- 100%。主要结局指标为活产率（> = 24周胎龄）。使用广义估计方程来解释来自同一受者的多个周期，并根据受者和供者年龄进行了先验调整。受体ET时血清P平均值为25.5±10.1 ng/mL。与P = 0.77, 95% CI = 0.60-0.94, P = 0.04相比，在ET时P < 20 ng/mL的受者，尽管ET后P剂量增加，实现临床妊娠（RR = 0.75, 95% CI = 0.60-0.94, P = 0.01）和活产（RR = 0.77, 95% CI = 0.60-0.98, P = 0.04）的可能性更小。在超重和肥胖的接受者中，P剂量的增加更为常见。新鲜供体IVF/ICSI周期ET当天血清P水平与临床妊娠和活产率呈正相关。ET后P剂量的增加不足以挽救妊娠率。超重和肥胖的接受者可能需要更高的初始磷补充剂量。未来的研究需要确定ET的最佳血清P和实现这一目标的干预措施。
To evaluate the association between serum progesterone (P) levels on the day of embryo transfer (ET) and pregnancy rates in fresh donor IVF/ICSI cycles.Fresh donor cycles with day 3 ET from 10/2007 to 8/2012 were included (n = 229). Most cycles (93 %) were programmed with a gonadotropin releasing hormone (GnRH) agonist; oral, vaginal or transdermal estradiol was used for endometrial priming, and intramuscular P was used for luteal support (50-100 mg/day). Recipient P levels were measured at ET, and P dose was increased by 50-100 % if < 20 ng/mL per clinic practice. The main outcome measure was rate of live birth (> = 24 weeks gestational age). Generalized estimating equations were used to account for multiple cycles from the same recipient, adjusted a priori for recipient and donor age.Mean recipient serum P at ET was 25.5 +/- 10.1 ng/mL. Recipients with P < 20 ng/mL at ET, despite P dose increases after ET, were less likely to achieve clinical pregnancy (RR = 0.75, 95 % CI = 0.60-0.94, p = 0.01) and live birth (RR = 0.77, 95 % CI = 0.60-0.98, p = 0.04), as compared to those with P a parts per thousand yenaEuro parts per thousand 20 ng/mL. P dose increases were more often required in overweight and obese recipients.Serum P levels on the day of ET in fresh donor IVF/ICSI cycles were positively correlated with clinical pregnancy and live birth rates. An increase in P dose after ET was insufficient to rescue pregnancy rates. Overweight and obese recipients may require higher initial doses of P supplementation. Future research is needed to define optimal serum P at ET and the interventions to achieve this target.