| Progesterone increased more common during ovulation stimulation.Evidence showed that premature increased progesterone had adverse effects of assisted reproductive technology.If progesterone on the day of HCG trigger higher than a certain threshold,it can be observed that pregnancy rate decreased in the IVF fresh cycle.The reason for the increase of progesterone level during ovarian stimulation is not yet clear,some studies have shown that superhuman dose FSH administration is one of the reasons for elevated progesterone levels,and HCG and LH activity may have a protective effect to prevent premature progesterone.There was some controversy on the assumption.Objective:To study the effect of LH activity to progesterone level on the day of HCG trigger during IVF-ET and the adverse effects of progesterone levels on clinical outcome of IVF-ET.Methods:Part ?:Retrospective analysis of 11065 persons,who experienced IVF-ET with long protocol or antagonist protocol in the First Affiliated Hospital of Nanjing Medical University in six years.Investigate the incidence of progesterone increased on the day of HCG trigger.Among them,6986 patients transfered in fresh cycles were divided into group A(HCG day progesterone<8nmol/L)and group B(HCG progesterone?8nmol/L)according to progesterone of HCG day,compared the clinical outcomes between two groups.Part ?:A prospective,multi-center,randomized clinical study included a total of 610 women undergoing long gonadotropin-releasing hormone(GnRH)agonist protocol for IVF treatment.The subjects were randomized into 2 groups:Group A received HP-HMG plus rFSH(n=305)while Group B received rFSH alone(n=305)to stimulate the ovaries.The progesterone on the day of HCG trigger and clinical outcomes were compared between two groups.Result(s):Part ?:There was no significant difference in the incidence of progesterone elevation between long protocol and antagonist protocol.The incidence in younger patients'group(?35 years)were significantly higher than those in older patients' group(>35 years).The estrogen level,total Gn dose,the number of oocytes obtained,the fertilization rate and the number of cleavage embryos transplantable were significantly higher in group B((progesterone of HCG day?8nmol/L)than those in group A(progesterone of HCG day<8nmol/L),while the clinical pregnancy rate,planting rate,twins rate,live births rate were significantly lower in group B than those in group A.Part ?:There was no significant difference in the demographic details and baseline investigation results between the two groups.The mean±SD progesterone(P)level on the day of hCG administration in group B(4.3±2.2nmol/l)is significantly(P<0.05)higher than that of group A(3.8±1.7mol/l).The mean±SD number of oocytes obtained in group B(12.9±5.6)is significantly(P<0.05)higher than that in group A(11.9±6.0).The fertilization rate in group B(69.2%)is significantly(P<0.05)lower than that in group A(73.9%).However,there was no difference in cleavage rate,implantation rate,clinical pregnancy rate and hyper-stimulation(OHSS)rate between the two groups,although the fresh transfer cancellation rate required to prevention OHSS in group A(34.8%)was significantly(P<0.05)lower than in group B(43.2%).Conclusion:Part I:Elevated levels of progesterone on the day of HCG trigger will have an adverse effect on the outcome of IVF.Since progesterone has no effect on the quality of oocytes and embryos,it can be inferred that change of endometrial receptivity during ovarian stimulation is the reason for the decrease of pregnancy rate nPart ?:In women undergoing long GnRHa protocol for IVF-ET,the use of HP-HMG plus rFSH led to a significantly lower mean P level on the day of hCG trigger,a significantly lower number of oocytes retrieved,a significantly higher fertilization rate and a significantly lower cancellation rate for fresh transfer to prevent OHSS compared with the use of rFSH alone,but there was no difference between the 2 groups in other clinical outcome measures.Clinical Trial Registration Number:ChiCTR-TRC-14004552.(Chinese Clinical Trial Registry,21 April 2014)... |
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