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 (5): 400-404.

• 综述 • 上一篇    下一篇

晚卵泡期血清孕酮提前升高对体外受精患者妊娠结局的影响及应对措施

马帅，李媛   

  1. 100020 首都医科大学附属北京朝阳医院生殖医学中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2016-10-25 发布日期:2016-10-25
  • 通讯作者: 李媛

Effect of Premature Progesterone Rise in Late Follicular Phase on Pregnancy Outcomes of IVF

MA Shuai, LI Yuan   

  1. Reproductive Medicine Center, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, Beijing 100020, China
  • Received:1900-01-01 Revised:1900-01-01 Published:2016-10-25 Online:2016-10-25
  • Contact: LI Yuan

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摘要： 体外受精-胚胎移植（in vitro fertilization and embryo transfer，IVF-ET）促排卵过程中血清孕酮提前升高（premature progesterone rise，PPR）的发生率为4.2%～36.0%，其对妊娠结局的影响一直存在争议，并且PPR影响妊娠结局的机制尚不完全清楚。另一方面，如何预防促排卵过程中出现的PPR是临床医生一直非常关注的问题。为明确上述问题，并为临床治疗提供线索，对相关文献进行综述，发现IVF促排卵过程中晚卵泡期PPR可能主要与肾上腺的作用、获卵数、人绒毛膜促性腺激素（human chorionic gonadotropin，hCG）日血清雌激素水平、卵泡刺激素（follicle stimulating hormone，FSH）使用剂量等有关，PPR可能主要通过影响子宫内膜而对新鲜周期ET的妊娠结局产生不利影响，对卵子或胚胎质量无不利影响，亦不影响冻融周期ET的妊娠结局。采用温和刺激、减少FSH剂量、适当控制获卵数、提前注射hCG等方法也许可以预防PPR；一旦发生PPR，建议全胚冷冻。虽然其中的某些方法可以改善IVF-ET妊娠结局，但是仍需高质量的大样本随机双盲对照研究证明其有效性。

关键词: 孕酮, 受精, 体外, 胚胎移植, 妊娠结局

Abstract: The incidence of premature progesterone rise (PPR) during ovarian stimulation in in vitro fertilization and embryo transfer(IVF-ET) ranges from 4.2% to 36.0%. The effect of PPR on the pregnancy outcomes still exists debate. How to prevent PPR is a challenge for doctors. To investigate this issue and offer clues for clinical treatment, we had a review. The PPR in late follicular phase during stimulation may be related to adrenal gland, the number of retrieved oocytes, the level of estradiol on the day of human chorionic gonadotropin (hCG) administration, and the dose of follicle stimulating hormone(FSH). PPR may adversely affect the pregnancy results in fresh cycles by affecting endometrium. PPR does not affect the oocyte or embryo quality and the pregnancy outcomes of the freezen-thaw cycles. PPR may be prevented by the mild simulation protocols, cutting down dose of FSH, controlling the number of retrieved oocytes, and advancing the trigger time. It should be advised to freeze all the embryo if PPR emerged. Although some treatments could effectively improve the pregnancy outcomes of IVF-ET, it is necessary to test their effectiveness by the high-quality randomly double-blind controlled clinical trials with large sample size．

Key words: Progesterone, Fertilization in vitro, Embryo transfer, Pregnancy outcome