Influence Of Changes Of Serum Estrogen And Progesterone Concentrations On Pregnancy Outcome Of Ivf-et In The Luteal Phase

Background: Assisted reproductive technology has been creating countless miracles for infertile patients. How to improve the clinical pregnancy rate has consistently been the goal of clinicians. In a number of factors that affect the outcome of IVF-ET, embryo implantation is considered to be the rate-limiting step of successful pregnancy. Successful implantation requires a competent blastocyst embryo interacting with a receptive endometrial lining. Endometrium is the direct target organ of estrogen and progesterone, which interact with each other coordinately. Controlled ovarian hyperstimulation (COH) promotes multiple follicular development that reduce cancellation rate with improvement of the pregnancy rate per cycle, but it may induce luteal insufficiency and inhibit the secretions of estrogen and progesterone, which may result in the impairment of endometrial receptivity as well. Therefore, studying the relationship between changes of estrogen and progesterone levels and IVF outcome plays an important role in predicting IVF outcome, and it becomes a hotspot in the reproductive area.Objective: To investigate the influence of changes of serum estradiol and progesterone concentrations from the day of human chorionic gonadotrophin (HCG) administration to luteal phase on pregnancy outcome of IVF-ET, which may provide reference to design individual protocol of the luteal supplementation effectively. Methods: PartⅠ: 125 IVF cycles with long controlled ovarian hyperstimulation were retrospectively analyzed. They were divided into 4 groups according to the ratio of serum estradiol concentration on the day of embryo transfer to that on the day of HCG administration: Group A: 24 cycles, the ratio < 0.4; Group B: 54 cycles, 0.4≤the ratio < 0.7; Group C: 32 cycles, 0.7≤the ratio < 1; Group D: 15 cycles, the ratio≥1.PartⅡ: 513 IVF cycles with long controlled ovarian hyperstimulation were prospectively studied, we analyzed serum estradiol and progesterone concentrations changes on the day of HCG administration, embryo transfer (ET) and three days after embryo transfer (ET+3 days).Firstly, the ROC analysis was made basing on the 119 cycles randomly selected from 265 ones in the preliminary experiment, through which we can get the cut point of each index reflecting the changes of serum estradiol and progesterone concentrations in the luteal phase. Then 513 cyles were divided into 3 groups according to these cut points of each index (①the ratio of serum estradiol concentration on ET+3 days to that on the day of HCG administration②the ratio of serum estradiol concentration on ET+3 days to that on the day of ET③the ratio of serum progesterone concentration on ET+3 days to that on the day of HCG administration④the ratio of serum progesterone concentration on ET+3 days to that on the day of ET): GroupⅠ: 174 cycles, All four indexes were lower than the cutoff values, as①E2 level on ET+3 days / E2 level on HCG day < 0.3 and②E2 level on ET+3 days / E2 level on ET day < 0.6 and③P level on ET+3 days / P level on HCG day < 45 and④P level on ET+3 days / P level on ET day < 0.5; GroupⅡ: 147 cycles,There were one, two or three indexes higher than or equal to the cutoff values; GroupⅢ: 192 cycles, All four indexes were higher than or equal to the cutoff values,as①E2 level on ET+3 days / E2 level on HCG day≥0.3 and②E2 level on ET+3 days / E2 level on ET day≥0.6 and③P level on ET+3 days / P level on HCG day≥45 and④P level on ET+3 days / P level on ET day≥0.5.Result: PartⅠ: Significantly lower implantation rate was found in group A compared with other groups (P<0.05); the implantation rate and pregnancy rate were significantly higher in group C compared with group A ( 31.51% VS 10.53%, 50% VS 20.83% ); nobody occurred early abortion in group C and no significant difference was found among other three groups in early abortion rate (P>0.05).PartⅡ: Significantly higher implantation rate and pregancy rate were observed in groupⅢ( 34.29% & 48.44%) compared with groupⅠas well as groupⅡ(P<0.05), but the differences in implantation rate and pregnancy rate were not significant between groupⅠandⅡ(P>0.05); Significantly higher preclinical abortion rate were observed in groupⅠ(10.92%) compared with groupⅡas well as groupⅢ(P<0.05), no significant difference was found in preclinical abortion rate between groupⅡandⅢ(P>0.05).Conclusion: The dramatic drop of estradiol and progesterone in the luteal phase especially in the mid-luteal period appends to indicate poor reproductive outcome of IVF cycles with a long controlled ovarian hyperstimulation. Monitoring serum estradiol and progesterone concentrations in the luteal phase plays an important role in predicting IVF outcome and making individual protocol of the luteal supplementation.