国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2016, Vol. 35 ›› Issue (2): 142-145.

• 综述 • 上一篇    下一篇

人绒毛膜促性腺激素日孕酮升高对体外受精的影响

王美仙，邵小光   

  1. 116000 大连市妇女儿童医疗中心，大连市生殖与遗传医学中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2016-03-15 发布日期:2016-03-15

Increased Level of Progesterone on the Day of hCG to the Disadvantage of IVF Outcomes

WANG Mei-xian，SHAO Xiao-guang   

  1. Dalian Municipal Women and Children′s Medical Center，Dalian Reproductive and Genetic Medicine Center，Dalian 116000，Liaoning Province，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2016-03-15 Online:2016-03-15

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摘要： 控制性卵巢刺激（controlled ovarian stimulation，COS）中，人绒毛膜促性腺激素（hCG）日孕激素升高时有发生。由于界定值不同，发生率报道亦不同。孕酮水平与成熟卵泡数目、雌二醇水平和总卵泡刺激素（FSH）剂量正相关。过早的孕酮升高可以改变子宫内膜基因表达，加速子宫内膜成熟，促使子宫内膜由分泌早期向分泌中期转变，导致子宫内膜和胚胎发育不同步，影响子宫内膜容受性。hCG日孕酮升高降低体外受精周期的种植率和活产率。选用温和的COS方案、减少FSH剂量、提前hCG诱发排卵时间、全胚冷冻后解冻移植、囊胚移植等方法可以避免孕酮升高导致的不利影响。

关键词: 绒毛膜促性腺激素, 孕酮, 超排卵, 受精, 体外, 妊娠率

Abstract: During controlled ovarian stimulation (COS), the concentration of serum progesterone sometimes increases on the day of human chorionic gonadotropin (hCG) administration. The occurrence rate of increased progesterone level was different, due to the different cutoff value based on some publications. The progesterone concentration is positively related to the number of mature follicles, the estradiol level and the total administration dose of follicle-stimulating hormone(FSH). The premature progesterone elevation could change endometrial gene expression, accelerate endometrial maturation, and affect endometrium from early- to mid-secretory phase, which result in the developmental asynchronism between endometrium and embryo, and affect the endometrial receptivity. The progesterone elevation on the day of hCG is negatively related to the implantation rate and the rate of live birth in IVF. Those negative effects of progesterone elevation can be avoided by the moderate COS protocol, the low dose of FSH, the earlier administration of hCG, the frozen-thawed embryo transfer, and the blastocyst embryo transfer.

Key words: Chorionic gonadotropin, Progesterone, Superovulation, Fertilization in vitro, Pregnancy rate