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目的:探讨晚卵泡期孕酮(P)水平上升对妊娠结局的影响,分析与P水平上升的相关因素并探讨其潜在机制。方法:回顾性分析1 083例IVF/ICSI患者的临床资料。根据hCG注射日血清P水平结合早发性LH峰将患者分为3组:低孕酮LH正常组(A组)、高孕酮LH正常组(B组)、高孕酮LH峰组(C组);根据hCG注射日卵泡数及E2水平将患者分为:卵巢正常反应组、卵巢高反应组。比较各组患者的临床特征、用药情况和妊娠结局。结果:P水平上升的最佳判断点为1.205 ng/ml。A、B和C组的临床妊娠率分别为51.0%、38.9%和28.6%(P=0.000),胚胎种植率分别为32.2%、24.9%和15.6%(P=0.001)。与A组相比,B和C组的Gn使用总量更高(P=0.000)、获卵数更多(P=0.000)。与B组相比,C组直径≥18 mm的卵泡数更少、E2水平更低、P水平上升更高,差异有统计学意义(P<0.05)。与卵巢正常反应组相比,卵巢高反应组同量用药情况下P水平上升更高。孕酮提前上升的相关因素为体质量指数(BMI)、基础FSH、hCG注射日最大卵泡直径、E2水平、Gn使用总量和Gn启动剂量。结论:晚卵泡期P水平提前上升不利于妊娠结局,但不影响卵母细胞及胚胎质量。卵巢自身反应性与FSH剂量是导致P水平提前上升的关键因素。
Objective: To investigate the effect of the rise of progesterone (P) on the outcome of pregnancy in the late follicle phase, and to analyze the related factors of the rise of P and its underlying mechanism. Methods: A retrospective analysis of 1 083 cases of IVF / ICSI clinical data. Patients were divided into 3 groups according to serum P level and early LH peak on the day of hCG injection: low progesterone LH normal group (group A), high progesterone LH normal group (group B), high progesterone LH peak group (C Group). According to the number of follicles and E2 level on the day of hCG injection, the patients were divided into normal ovarian response group and high ovarian response group. The clinical characteristics, medication status and pregnancy outcome of each group were compared. Results: The best judgment point of P level rise was 1.205 ng / ml. Clinical pregnancy rates in groups A, B and C were 51.0%, 38.9% and 28.6%, respectively (P = 0.000). Embryo implantation rates were 32.2%, 24.9% and 15.6%, respectively (P = 0.001). Compared with group A, the total amount of Gn use in groups B and C was higher (P = 0.000) and the number of oocytes was more (P = 0.000). Compared with group B, group C had a smaller number of follicles ≥ 18 mm in diameter, lower E2, and higher P levels, with a significant difference (P <0.05). Compared with the normal ovarian response group, the P level in the ovarian hyperresponsiveness group increased with the same dosage. Progesterone increased in advance related factors such as body mass index (BMI), basal FSH, the largest follicular diameter of hCG injection day, E2 levels, total Gn use and Gn-initiated dose. Conclusion: The early stage of late follicular phase P level rise is not conducive to pregnancy outcomes, but does not affect oocyte and embryo quality. Ovarian self-reactivity and FSH dosage are the key factors leading to the early rise of P level.