| Objective1.To investigate the correlation between progesterone levels,progesterone-oocyte-index on the trigger day and pregnancy outcome in fresh cycle of in vitro fertilization-embryo transfer.2.To calculate the cut-off values of progesterone and progesterone-oocyte-index on the trigger day leading to adverse pregnancy outcome.3.To explore the factors resulting in abnormal alterations in progesterone levels on the trigger day.4.To establish an effective decision tree model for predicting pregnancy outcomes in fresh cycles.MethodsThe medical records of infertile women who underwent in vitro fertilization-embryo transfer treatment in the Reproductive Center of the Second Norman Bethune Hospital of Jilin University from December2019 to December 2021 were retrospectively analyzed.Finally,903 fresh cycles that met the inclusion and exclusion criteria were selected as the subjects of this study.The relationship between the progesterone levels,progesterone-oocyte-index on the trigger day and pregnancy outcome were analyzed by statistical methods.The receiver operator characteristic curve was used to calculate the cut-off value of progesterone and progesterone-oocyte-index for cursing adverse pregnancy outcomes.To further explore the influencing factors of abnormal progesterone levels on the trigger day.A validated decision tree model was established by combining progesterone and progesteroneoocyte-index on the trigger day to predict the pregnancy outcomes of fresh in vitro fertilization-embryo transfer cycles.Results1.A total of 903 fresh embryo transfer cycles undergoing in vitro fertilization-embryo transfer were comprehended in this study,including 388 cycles in the clinical pregnancy group and 515 cycles in the non-pregnancy group.There was no statistical difference between the two groups in body-mass-index,infertility years,infertility type,medication regimen,basal hormone level,antral follicle count,total amount,days and initiation of gonadotropins,total amount of trigger drugs and endometrial thickness on the trigger day.In contrast,significant differences were found in age,estrogen,progesterone,luteinizing hormone,progesterone-oocyte-index,the number of follicles,the number of follicles ≥ 14 mm in diameter on the trigger day and the number of retrieved oocytes.Compared with the non-pregnant group,the clinical pregnancy group was younger,and the levels of progesterone,luteinizing hormone,and progesterone-oocyte-index on the trigger day were lower,while the estrogen,the number of follicles,the number of follicles with diameters ≥ 14 mm on the trigger day,and the number of retrieved oocytes were more.2.Logistic regression analysis showed that age,progesterone,progesterone-oocyte-index on the trigger day and number of oocytes retrieved were independent risk factors affecting pregnancy outcomes.With the increase of age,the level of progesterone and progesteroneoocyte-index on the trigger day,the pregnancy rate gradually decreased,while the pregnancy rate gradually increased with increasing of the number of retrieved oocytes.3.The cut-off value of progesterone on the trigger day with adverse effects on pregnancy outcome was 1.39 ng/mL,and the progesterone-oocyte-index was 0.1422 ng/mL per oocyte.The area under the curve for progesterone levels and progesterone-oocyte-index on the trigger day for predicting clinical pregnancy outcomes were 0.63(95%CI 0.59-0.66,P < 0.01)and 0.72(95% CI 0.69-0.76,P < 0.01),respectively.4.There was no significant difference in the general condition and drug dosage of patients with different progesterone levels on the trigger day(progesterone was 1.39 ng/mL as the grouping index),but the trigger day indexes,laboratory indexes and pregnancy outcomes were different.The estrogen,the number of follicles,the number of follicles with diameters ≥ 14 mm on the trigger day and the number of oocytes retrieved in the high-level group were higher than those in the low-level group.The number of mature oocytes,fertilized cells,normal cleavage cells and high-quality embryos were higher in the highlevel group than those in the low-level group.But there were no significant differences in the mature oocyte rate,fertilization rate,cleavage rate,and high-quality embryo rate in the two groups.The clinical pregnancy,the continuous pregnancy rate and abortion rate of the high-level group was significantly lower than those of the lowlevel group.5.The general condition and dosage of patients with different progesterone-oocyte-index on the trigger day were similar,but the cycle characteristics,laboratory results and pregnancy outcomes were different.The dividing line between the two groups was 0.1422 ng/mL per egg.The luteinizing hormone on the trigger day in the high-level group was higher than in the low-level group,while the estrogen,follicles numbers,the number of follicles with diameters ≥ 14 mm on the trigger day and the number of oocytes retrieved were lower than those in the low-level group.The number of mature oocytes,the number of fertilized cells,the number of normal cleavage cells and the number of high-quality embryos in the high-level group were lower than those in the low-progesterone-level group,but there was no obvious difference in the mature oocyte rate,cleavage rate and high-quality embryo rate between the two groups.The pregnancy rate of the highlevel group was visibly lower than that of the low-level group,but the abortion rate of the low-level group was higher than that of the high-level group.6.The logistic regression analysis suggested that luteinizing hormone,number of follicles,number of follicles with diameters ≥ 14 mm on the trigger day and number of oocytes retrieved were the independent factors of elevating serum progesterone levels on trigger day.The risk of progesterone elevation increases with the decrease of luteinizing hormone on the trigger day,and the increase of the number of follicles,the number of follicles with diameter ≥ 14 mm and the number of retrieved oocytes.7.When combining progesterone and progesterone-oocyte-index on the trigger day together to predict the pregnancy outcome of patients in the fresh cycle of in vitro fertilization-embryo transfer,it was found that it was better than any single factor,and the overall prediction efficiency was 70.4 %.Conclusion1.Age,estrogen,progesterone,luteinizing hormone,progesteroneoocyte-index,number of follicles,number of follicles ≥ 14 mm in diameter on the trigger day,and number of oocytes retrieved are all factors affecting pregnancy outcome.2.Age,progesterone,progesterone-oocyte-index on the trigger day and number of oocytes retrieved are independent risk factors for pregnancy outcome,with progesterone-oocyte-index having a greater impact on clinical pregnancy,while progesterone a slightly effect.3.The indicators related to the abnormal elevated of progesterone on the trigger day include luteinizing hormone,follicle count,the number of follicles ≥ 14 mm in diameter on the trigger day and the number of oocytes retrieved.4.The decision tree model of predicting the pregnancy outcome of in vitro fertilization-embryo transfer combined with progesterone and progesterone-oocyte-index on the trigger day is more effective. |
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