Defining thresholds for abnormal premature progesterone levels during ovarian stimulation for assisted reproduction technologies
Defining thresholds for abnormal premature progesterone levels during ovarian stimulation for assisted reproduction technologies
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DOI：
10.1016/j.fertnstert.2018.05.007
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发表时间：
2018-09-01
影响因子：
6.7
通讯作者：
Patounakis, George
中科院分区：
文献类型：
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作者：
Hill, Micah J.;Healy, Mae Wu;Patounakis, George
目的：评价推荐冷冻周期触发当日孕酮(P)水平异常的方法学。设计：阈值分析和成本分析。背景：私人艺术实践。患者(S)：新鲜自体ART。干预(S)：无。主要结果衡量(S)：活产。结果(S)：14种建立临床阈值的统计方法。这些方法被应用于7608个新鲜ART移植周期，以产生不同的P阈值，范围从0.4到3.0 ng/mL。下限阈值从0.4到1 ng/ml不等，并将大多数周期归类为异常周期，以及需要非常大量的治疗(NNT)才能增加一次活产。当P=1.5 ng/m L时，冷冻胚胎移植具有成本效益，有12%的人群检测结果异常，NNT为13。统计学和成本-效果阈值集中在1.5-2.0 ng/m L之间。结论：P的阈值低至0.4 ng/m L，但NNT很大，可增加1个活产。仅冷冻方法的临床益处被证明高于P阈值，范围从1.5到2.0 ng/dL。在这些阈值下，升高的P具有明显的和临床上显著的负面影响，并捕获了较小比例的患者群体，具有新的转移失败的更高风险，因此使仅冷冻成为一种经济有效的选择。(C)2018年，由美国生殖医学学会主办。
Objective: To evaluate methodologies to establish abnormal progesterone (P) levels on the day of trigger for recommending freeze only cycles.Design: Threshold analysis and cost analysis.Setting: Private ART practice.Patient(s): Fresh autologous ART.Interventions(s): None.Main Outcome Measure(s): Live birth.Result(s): Fourteen established statistical methodologies for generating clinical thresholds were evaluated. These methods were applied to 7,608 fresh ART transfer cycles to generate various P thresholds which ranged widely from 0.4 to 3.0 ng/mL. Lower thresholds ranged from 0.4 to 1 ng/mL and classified the majority of cycles as abnormal as well as required very large number needed to treat (NNT) to increase one live birth. Frozen embryo transfer was cost-effective when P was >= 1.5 ng/mL, with 12% of the population having an abnormal test result and an NNT of 13. Statistical and cost-effective thresholds clustered between 1.5 and 2.0 ng/mL.Conclusion(s): Statistically significant thresholds for P were demonstrated as low as 0.4 ng/mL but resulted in a very large NNT to increase one live birth. A clinical benefit to a freeze-only approach was demonstrated above P thresholds ranging from 1.5 to 2.0 ng/dL. At these thresholds, elevated P has a demonstrable and clinically significant negative effect and captures a smaller percentage of the patient population at higher risk for fresh transfer failure, thus making freeze-only a cost-effective option. (C) 2018 by American Society for Reproductive Medicine.