Effects of trigger-day progesterone in the preimplantation genetic testing cycle on the embryo quality and pregnancy outcomes of the subsequent first frozen-thawed blastocyst transfer.
Effects of trigger-day progesterone in the preimplantation genetic testing cycle on the embryo quality and pregnancy outcomes of the subsequent first frozen-thawed blastocyst transfer.
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DOI：
10.3389/fendo.2023.990971
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发表时间：
2023
影响因子：
5.2
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评估植入前遗传学检测（PGT）周期中触发日的孕酮（P）水平是否与随后第一个冻融囊胚移植（FET）周期的胚胎质量和妊娠结局相关。在这项回顾性分析中，招募了504例在2014年12月至2019年12月期间接受ICSI，随后进行冷冻解冻胚胎移植（FET）并进行植入前遗传学检测（PGT）的合格患者。所有患者均采用相同的方案，即黄体中期短效促性腺激素释放激素激动剂长方案。当在人绒毛膜促性腺激素（HCG）给药当天测量血清P时，临界P值为0.5和1.5 ng/ml，并根据HCG给药当天的P水平对周期进行分组。此外，还评估了孕早期孕酮对胚胎质量和随后的FET临床结局的影响。总共分析了504个PGT周期。三组间的整倍体囊胚数、优质囊胚数、整倍体率和流产率差异均无统计学意义（P>0.05）。2 PN受精率（80.32%vs.80.17%vs.79.07%）和优质囊胚率（8.71%vs.8.24%vs.7.94%）随P的增加呈下降趋势，组间比较差异不显著（P>0.05）。高磷组在随后的FET周期中的临床妊娠率（41.25% vs. 64.79%; P<0.05）和活产率（35.00% vs. 54.93%; P<0.05）显著低于P ≤ 0.5 ng/ml组。在对混杂变量进行调整后，多因素Logistic回归分析显示，高P值组的临床妊娠率较低（调整OR，0.317; 95%CI，0.145-0.692; P=0.004）和活产率在随后的FET周期中，低磷组（校正OR，0.352; 95% CI，0.160-0.773; P=0.009）的患者的生存率高于低磷组，差异有统计学意义。这项研究表明，在PGT人群中，触发日P升高可能会降低优质囊胚率（尽管整倍体率没有差异）。触发日P是影响后续FET周期临床结局的重要因素。
To assess whether progesterone (P) levels on the trigger day during preimplantation genetic testing (PGT) cycles are associated with embryo quality and pregnancy outcomes in the subsequent first frozen-thawed blastocyst transfer (FET) cycle. In this retrospective analysis, 504 eligible patients who underwent ICSI followed by frozen-thawed embryo transfer (FET) with preimplantation genetic test (PGT) between December 2014 and December 2019 were recruited. All patients adopted the same protocol, namely, the midluteal, short-acting, gonadotropin-releasing hormone agonist long protocol. The cutoff P values were 0.5 and 1.5 ng/ml when serum P was measured on the day of human chorionic gonadotropin (HCG) administration, and cycles were grouped according to P level on the day of HCG administration. Furthermore, the effect of trigger-day progesterone on embryo quality and the subsequent clinical outcome of FET in this PGT population was evaluated. In total, 504 PGT cycles were analyzed. There was no significant difference in the number of euploid blastocysts, top-quality blastocysts, euploidy rate, or miscarriage rate among the three groups (P>0.05). The 2PN fertilization rate (80.32% vs. 80.17% vs. 79.07%) and the top-quality blastocyst rate (8.71% vs. 8.24% vs. 7.94%) showed a downward trend with increasing P, and the between-group comparisons showed no significant differences (P>0.05). The clinical pregnancy rate (41.25% vs. 64.79%; P<0.05) and live birth rate (35.00% vs. 54.93%; P<0.05) in subsequent FET cycles were substantially lower in the high-P group than in the P ≤ 0.5 ng/ml group. After adjustments were made for confounding variables, multivariate logistic regression analysis revealed that the high-P group had a lower clinical pregnancy rate (adjusted OR, 0.317; 95% CI, 0.145–0.692; P=0.004) and live birth rate (adjusted OR, 0.352; 95% CI, 0.160–0.773; P=0.009) than the low-P group in subsequent FET cycles, and the differences were significant. This study demonstrates that in the PGT population, elevated P on the trigger day may diminish the top-quality blastocyst rate (although there is no difference in the euploidy rate). Trigger-day P is an important factor influencing clinical outcomes in subsequent FET cycles.