Relationship Between Serum Progesterone/Estradiol Levels And The Outcome In Vitro Fertilization And Embryo Transfer

Objective To analyze the relationship between serum E₂,P level,P/E₂ ratio and E₂/MII oocytes ratio and the outcome of assisted pregnancy in hCG day of IVF/ICSI-ET cycle,and to explore the predictive value of P/E₂ ratio and E₂/MII oocytes ratio for treatment outcome.It is clearly suitable for the reference standard of the center,and provides a theoretical basis for improving embryo utilization and cumulative clinical pregnancy rate.Methods Retrospective analysis of 770 cases of infertility patients who underwent IVF/ICSI-ET assisted pregnancy in the Reproductive Medicine Center of Ningxia Medical University General Hospital in September 2016 and September 2018,a total of 1062 cycles.According to the E₂ level of hCG day,it is divided into three groups:A1 group:E₂<2500pg/ml（596 cycles）,A2 group:2500≤E₂<5000pg/ml（368 cycles）,A3 group:E₂≥5000pg/ml（98 cycles）;according to P content in three groups,B1group:P<1.0ng/ml（646 cycles）,B2 group:1.0≤P<2.0ng/ml（356 cycles）,B3 group:P≥2.0ng/ml（60 cycles）;according to the P/E₂ ratio in three groups,C1 group:P/E2<1.0（942 cycles）,C2 group:1.0≤P/E₂<2.0（84 cycles）,C3 group:P/E₂≥2.0（36cycles）;divided into two groups according to the E₂/MII oocytes ratio,D1 group:E₂/MII oocytes<264 pg/ml（545 cycles）,D2 group:E₂/MII oocytes≥264 Pg/ml（517cycles）;divided into pregnancy group（575 cycles）and non-pregnant group（487 cycles）according to pregnancy outcome.The differences in ovarian reserve function,ovarian response,laboratory parameters,and clinical outcomes were compared between groups.Using SPSS22.0 software,the measurement data was expressed as?x±S.The t test was used for comparison between the two groups.The variance analysis was used for comparison between groups.The count data was described by%,and the?² test was used for comparison between groups.Pearson correlation analysis was used.Results（1）The number of eggs,MII eggs,number of transplantable embryos and embryo freezing rate in A3 group were significantly higher than those in A1 and A2groups（both P<0.001）.Serum E₂ levels were significantly higher than the number of eggs obtained,MII eggs and transplantable embryos.Positive correlation（r=0.626,r=0.487,r=0.196,both P<0.001）.（2）The number of eggs,MII eggs,excellent embryo rate,persistent pregnancy rate and OHSS incidence in group B1 were significantly lower than those in group B2 and B3（P<0.001,P<0.05,P<0.05,P<0.001,P<0.05,respectively）.（3）The number of eggs,MII eggs,number of transplantable embryos,embryo freezing rate and clinical pregnancy rate in C1 group were significantly higher than those in C2 and C3 groups（P<0.001,P<0.001,P<0.001,P<0.001,P<0.05,respectively）.（4）The number of MII eggs,transplantable embryos,fertilization rate,embryo freezing rate and embryo implantation rate in D1 group were significantly higher than those in D2 group（both P<0.001）,while the incidence of OHSS was significantly lower than that in D2 group（P<0.05）.The E₂/MII egg ratio was significantly negatively correlated with the number of MII eggs and transplantable embryos（r=-0.365,r=-0.236,both P<0.001）.（5）The ratio of serum P and P/E₂ in hCG day of pregnancy group was significantly lower than that in non-pregnant group（both P<0.05）.Conclusions（1）Serum E₂ level is may not be a key factor affecting the clinical pregnancy rate,but it is of great benefit to improve the cumulative pregnancy rate.（2）When hCG daily serum P≥2ng/ml,it is recommended to eliminate fresh embryo implantation and elective frozen embryo transfer to improve embryo utilization.（3）The hCG Day P/E₂ ratio can be used as a parameter to predict the outcome of IVF/ICSI-ET.In the luteal support,the appropriate dose of estradiol is supplemented to adjust the ratio.（4）The E₂/MII oocytes ratio is also one of the latest indicators for assessing IVF/ICSI-ET pregnancy outcomes.