| Objective:To explore the effect of serum E2,P levels and changes on pregnancy outcomes the next day after trigger,and to provide a new predictive basis for the clinical outcome of IVF/ICSI-ET ovulatory cycle.Methods:This study is a single-center,retrospective study.The subjects of the study were patients who underwent IVF/ICSI-ET treatment at the Reproductive Medicine Center of the First Affiliated Hospital of Hainan Medical College from October 2017 to October 2019.A total of 1040 treatment cycles were included in the luteal phase long regimen,follicular phase long regimen,and antagonist regimen.Divided into pregnancy success group and pregnancy failure group according to whether pregnancy was obtained.According to the 50th percentile of serum E2 level of trigger the next day,patients were divided into high E2 group(520 cycles):E2≥12100pmol/1 and low E2 group(520 cycles):E2<12100pmol/l.According to the increase of serum E2 level concentration after trigger,it is divided into ascending group(≥10%),level group(±10%),and descending group(≤10%).Patients were divided into thre e groups based on E2 change,with 105cases exhibiting E2 reduction>10%,268cases showing E2 change at±10%and 667cases revealing E2increase≥10%.According to the increase of serum P concentration after Trigger,it is divided into four groups,the increase of P concentration in group I is less than or equal to 25%(≤8.09pmol/l),and the increase of P concentration in group Ⅱ is between 25%and 50%(8.09pmol/l<P≤12.45pmol/l),Group Ⅲ P concentration increased between 50%and 75%(12.45pmol/l<P≤17.66pmol/l),Group Ⅳ P concentration increased more than 75%(>17.66pmol/1).Parametric or non-parametric tests were used to compare the differences in general characteristics,ovarian stimulation,laboratory indicators,and clinical outcomes between groups.Logistic regression analysis models were used to assess the influencing factors related to clinical pregnancy,while adjusting for potential confounding factors.Results:Part Ⅰ:The effect of Trigger serum E2 and P levels on pregnancy outcomes1.Univariate and multivariate analysis of clinical pregnancy-related:the female age and infertility years of the successful pregnancy group were lower than the pregnancy failure group(P<0.05),while the AMH,number of oocytes received,high-quality embryo number,intrauterine of the successful pregnancy group Membrane thickness and E2 level of Trigger the next day were higher than those of pregnancy failure group(P<0.05).Multivariate Logistic regression analysis was performed on the above univariate analysis results,and it was concluded that female age,number of high-quality embryos,endometrial thickness,and trigger E2 level the next day were independent factors affecting pregnancy2.The fertilization rate of the high E2 group was lower than that of the low E2 group on the next day of trigger,and the number of oocytes,implantation rate and pregnancy rate of the high E2 group were significantly higher than that of the low E2 group(P<0.05)Part II:The effect of changes in E2 and P concentrations on clinical outcomes after trigger1.The pregnancy rate in the group with increased serum E2 concentration after Trigger was significantly higher than that in the decreased group(1).Pairwise comparison between ascending group(≥10%),plane group(±10%),and descending group(≤10%),among which ascending group’s number of oocytes obtained and pregnancy rate were significantly higher than that of descending group,the difference was statistically significant Significance(P<0.05).The rate of excellent embryos in the ascending group was lower than that in the horizontal group,and the difference was statistically significant(P<0.05).There was no significant difference in the planting rate among the three groups(P>0.05),but the rising group had the highest implantation rate.(2).In multi-factor ordered logistic regression,the total dose of basal FSH and Gn is an independent risk factor(P<0.05)that affects the change of serum E2 concentration after Trigger;The pregnancy rate was still statistically significant in the ascending group(E2≥10%)compared with the decreasing group(E2≤10%)(P<0.05).2.The change of serum P concentration after trigger was positively correlated with the number of oocytes harvested,but it does not affect the fertilization rate.high-quality embryo rate、implantation rate and clinical pregnancy rate.(1).The number of oocytes acquired in the four groups showed an increasing trend with the increasing trend of P concentration after trigger,and there were significant differences between the groups(P<0.05).There were no statistically significant differences in the fertilization rate,excellent embryo rate,implantation rate,and pregnancy rate among the four groups(P>0.05),but the implantation rate and pregnancy rate in group Ⅰ lowest.(2).Ordinary least square regression models and logistic regression analyses,after adjust the age,basic FSH level,AMH,Gn total dose,and trigger serum E2 level the next day,the correlation between P increase after trigger and oocytes retrieved was statistically Academic significance(P<0.001).Additionally,mature oocyte rate,fertilization rate,good quality embryo rate,implantation rate and pregnancy rate were not significantly associated with the increase of P levels when adjusting for the same factors((P>0.05)).Female age and basal FSH level are negatively correlated with the number of eggs harvested(P<0.001)Conclusions1.E2 level on the next day of trigger is one of the independent factors affecting clinical pregnancy2.It is easier to get a pregnancy when the E2 concentration rises by more than 10%after the trigger.Therefore,we suggest that the change in the E2 concentration after the trigger can be used as one of the reference indicators for predicting IVF/ICSI pregnancy outcomes3.The degree of P concentration change after the trigger has a greater predictive value for the number of oocytes retrieved,and can be used as one of the additional indicators to predict the number of oocytes retrieved together with age and ovarian function. |
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