IS THE LUTEO-PLACENTAL SHIFT A MYTH - ANALYSIS OF LOW PROGESTERONE LEVELS IN SUCCESSFUL ART PREGNANCIES
IS THE LUTEO-PLACENTAL SHIFT A MYTH - ANALYSIS OF LOW PROGESTERONE LEVELS IN SUCCESSFUL ART PREGNANCIES
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DOI：
10.1210/jc.77.1.195
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发表时间：
1993-07-01
影响因子：
5.8
通讯作者：
HEALY, DL
中科院分区：
文献类型：
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作者：
AZUMA, K;CALDERON, I;HEALY, DL
黄体酮 (P4) 被认为对于维持人类妊娠至关重要，但维持人类妊娠所需的 P4 最低浓度仍不清楚。本研究的目的是检查一组辅助生殖技术 (ART) 患者妊娠早期血清 P4、17β-雌二醇 (E2) 和人 (h) β-CG 的内分泌谱。这些受试者正常分娩，但自 ART 后 2 周起，P4 浓度低于正常单胎妊娠范围的第五个百分位。这些激素的正常范围是根据 118 次连续 ART 妊娠（导致单胎出生）确定的。低于第五个百分位的值（妊娠 4 周时 P4 < 35.9 nmol/L）被认为是异常的。发现 8 名患者随后正常分娩，但在妊娠 4 周时血清 P4 值低于此标准。他们在妊娠 4 周时的血清 P4 值范围为 1.9-29.9 nmol/L，其在妊娠 5 周时的平均 P4 值（30.2 +/- 9.2 nmol/L；平均值 +/- SE）和妊娠 6 周时的平均 P4 值（48.0 +/- 10.2 nmol/L）仍低于第五百分位。这些妇女在妊娠 7 周至 11 周期间血清 P4 浓度没有出现统计学上的显着增加。妊娠 4 周时血清中的平均 E2 值 (382 +/- 73 pmol/L) 也低于第五百分位，但平均 β-hCG 浓度在正常范围内。我们的结论是，妊娠早期血清 P4 值在无排卵范围内时，人类成功妊娠是可能的，并且在个体患者中，2 nmol/L 的血清 P4 浓度足以维持人类妊娠。
Progesterone (P4) is considered vital to the maintenance of human pregnancy, but the minimal concentration of P4 necessary to sustain human pregnancy remains unclear. The aim of this study was to examine endocrine profiles for serum P4, 17beta-estradiol (E2), and human (h) beta-CG in early pregnancy from a group of assisted reproductive technologies (ART) patients. These subjects delivered normally but had P4 concentrations below the fifth percentile of the normal singleton pregnancy range from 2 weeks after ART. Normal ranges of these hormones were determined from 118 consecutive ART pregnancies which resulted in singleton births. Values below the fifth percentile (P4 < 35.9 nmol/L at 4 weeks gestation) were considered abnormal. Eight patients who subsequently delivered normally, with serum P4 values below this criterion at 4 weeks gestation, were found. They had serum P4 values at 4 weeks gestation ranging from 1.9-29.9 nmol/L, and their mean P4 values at 5 weeks (30.2 +/- 9.2 nmol/L; mean +/- SE) and 6 weeks gestation (48.0 +/- 10.2 nmol/L) remained below the fifth percentile. No statistically significant increase in serum P4 concentrations occurred between 7 and 11 weeks gestation in these women. Their mean E2 value in serum at 4 weeks gestation (382 +/- 73 pmol/L) was also below the fifth percentile but their mean beta-hCG concentration was within the normal range. We conclude that successful human pregnancy is possible with serum P4 values within the anovulatory range in early gestation and that, in individual patients, serum P4 concentration of 2 nmol/L can be sufficient to maintain human pregnancy.