国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2014, Vol. 33 ›› Issue (4): 310-313.

• 综述 • 上一篇    下一篇

hCG注射日孕酮升高对体外受精-胚胎移植的影响

曲娟，吴夏迪，冒韵东   

  1. 210029 南京医科大学第一附属医院生殖医学中心
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2014-07-15 发布日期:2014-07-15
  • 通讯作者: 冒韵东

Effect of Elevated Progesterone on the Day of hCG Administration during Ovarian Stimulation on IVF-ET

QU Juan，WU Xia-di，MAO Yun-dong   

  1. Reproductive Medical Center，First Affiliated Hospital，Nanjing Medical University，Nanjing 210029，China
  • Received:1900-01-01 Revised:1900-01-01 Published:2014-07-15 Online:2014-07-15
  • Contact: MAO Yun-dong

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摘要： 体外受精-胚胎移植（in vitro fertilization-embryo transfer，IVF-ET）过程中，在卵泡晚期人绒毛膜促性腺激素（hCG）注射日孕酮水平升高是否与妊娠结局有相关性，尚无统一的意见。针对这一问题，基于国内外的研究成果围绕hCG注射日孕酮水平升高对IVF结局的影响，首先阐明孕酮主要由卵泡颗粒细胞产生，而促排卵方案中多种因素可导致孕酮水平升高。其次从激素环境、卵母细胞的质量及子宫内膜的容受性方面综述了孕酮升高影响IVF结局的机制。然后，系统阐述了孕酮升高对IVF结局影响的实证研究，并进一步分析孕酮通过改变子宫内膜容受性而最终降低妊娠率。最后，在这些研究基础上，指导临床医生优化促排卵方案或移植方案，尽可能地改善实验室及临床结局，也为下一步研究微刺激/自然周期IVF提供理论依据。

关键词: 受精, 体外, 胚胎移植, 减量调节, 排卵诱导, 孕酮

Abstract: There is a debate regarding the impact of the raised level of progesterone on the day of chorionic gonadotrophin （hCG） administration during late follicular phase on the outcomes of in vitro fertilization （IVF）. Based on hypothesis that the raised level of progesterone on the day of hCG injection affect IVF outcome, it was found that progesterone was produced by follicular granulosa cells, and that a variety of factors increased the progesterone production during ovarian stimulation. The effects of the raised level of progesterone on IVF outcomes were reviewed, including hormone, oocyte quality and endometrial receptivity. We can conclude that the raised progesterone could reduce the pregnant rate by the lowered endometrial receptivity. This review will be helpful for doctors to optimize their protocols of ovarian stimulation and/or embryonic transplantation, so as to improve IVF outcomes and to explore new protocol of ovarian mini-stimulation/natural cycle.

Key words: Fertilization in vitro, Embryo transfer, Down-regulation, Ovulation induction, Progesterone