打破卵針當天早上抽E2，24h後再抽E2，若第二次E2不升反降，懷孕率較低
http://humrep.oxfordjournals.org/content/27/9/2690.full
A decrease in serum estradiol levels after human chorionic gonadotrophin administration predicts significantly lower clinical pregnancy and live birth rates in in vitro fertilization cycles
BACKGROUND Although close observation of serum estradiol (E2) levels remains a mainstay of assessing clinical response to controlled ovarian stimulation, the prognostic value of any change in E2 levels after administration of hCG remains unclear. The objective of this study is to evaluate the relationship between serum E2 response after hCG administration and the clinical pregnancy and live birth rates in fresh IVF cycles.
METHODS We conducted a retrospective cohort study of women aged 21–45 years undergoing their first IVF cycle from 1999 to 2008 at a single practice. We compared the post-hCG serum E2 level with values on the day of hCG trigger. IVF cycles were stratified by post-hCG E2 response and appropriate parametric and non-parametric statistics were performed. Clinical intrauterine pregnancy and live births were the primary outcomes of interest. Multivariable logistic regression models were created to identify predictive factors associated with outcomes while adjusting for potential confounders.
RESULTS Among the 1712 IVF cycles, 1065 exhibited a >10% increase (Group A), 525 had a plateau (±10%, Group B) and 122 showed a >10% decrease (Group C) in post-hCG E2 levels. While the E2 levels on the day of hCG were similar across groups, Group C had more patients with diminished ovarian reserve, required higher gonadotrophin doses and had the lowest implantation rates. After adjusting for age, total gonadotrophin dose, infertility diagnosis, number of oocytes and number of transferred embryos, the associations between post-hCG E2 decline (Group C) and clinical pregnancy [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.33–0.84, P= 0.007] and live birth (aOR: 0.40; 95% CI: 0.22–0.71, P= 0.002) were significant. We also found significant associations between E2 plateau (Group B) and clinical pregnancy (aOR: 0.73; 95% CI: 0.57–0.94, P= 0.013) and live birth (aOR: 0.74; 95% CI: 0.56–0.97, P= 0.032) when adjusting for the same factors.
CONCLUSIONS In our study, >10% decrease in E2 levels after hCG administration was associated with 40–50% reduction in clinical pregnancy and live birth rates. Similarly, post-hCG E2 plateau (±10%) lowered the clinical pregnancy and live birth rates by >25%. Our study suggests that the change in the post-hCG E2 level is another parameter that can be used by clinicians to counsel patients regarding their likelihood of success with assisted reproductive technologies prior to oocyte retrieval.
METHODS We conducted a retrospective cohort study of women aged 21–45 years undergoing their first IVF cycle from 1999 to 2008 at a single practice. We compared the post-hCG serum E2 level with values on the day of hCG trigger. IVF cycles were stratified by post-hCG E2 response and appropriate parametric and non-parametric statistics were performed. Clinical intrauterine pregnancy and live births were the primary outcomes of interest. Multivariable logistic regression models were created to identify predictive factors associated with outcomes while adjusting for potential confounders.
RESULTS Among the 1712 IVF cycles, 1065 exhibited a >10% increase (Group A), 525 had a plateau (±10%, Group B) and 122 showed a >10% decrease (Group C) in post-hCG E2 levels. While the E2 levels on the day of hCG were similar across groups, Group C had more patients with diminished ovarian reserve, required higher gonadotrophin doses and had the lowest implantation rates. After adjusting for age, total gonadotrophin dose, infertility diagnosis, number of oocytes and number of transferred embryos, the associations between post-hCG E2 decline (Group C) and clinical pregnancy [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.33–0.84, P= 0.007] and live birth (aOR: 0.40; 95% CI: 0.22–0.71, P= 0.002) were significant. We also found significant associations between E2 plateau (Group B) and clinical pregnancy (aOR: 0.73; 95% CI: 0.57–0.94, P= 0.013) and live birth (aOR: 0.74; 95% CI: 0.56–0.97, P= 0.032) when adjusting for the same factors.
CONCLUSIONS In our study, >10% decrease in E2 levels after hCG administration was associated with 40–50% reduction in clinical pregnancy and live birth rates. Similarly, post-hCG E2 plateau (±10%) lowered the clinical pregnancy and live birth rates by >25%. Our study suggests that the change in the post-hCG E2 level is another parameter that can be used by clinicians to counsel patients regarding their likelihood of success with assisted reproductive technologies prior to oocyte retrieval.
Table II
IVF cycle outcomes by serum estradiol response to hCG administration
| Group A (>10% rise), n = 1065 | Group B (±10% plateau), n= 525 | Group C (>10% fall), n= 122 | P-value | |
|---|---|---|---|---|
| Hormone response to hCG | ||||
| Day of hCG E2 (pg/ml) | 3017 ± 1331 | 3010 ± 1380 | 3194 ± 1430 | 0.56 |
| Post-hCG E2 (pg/ml) | 4051 ± 1898 | 3059 ± 1413 | 2639 ± 1157 | 0.0001a,†,b,†,c |
| Day of hCG LH (mIU/ml) | 1.8 ± 1.3 | 1.8 ± 1.3 | 1.5 ± 1.1 | 0.08 |
| Post-hCG LH (mIU/ml) | 1.4 ± 3.2 | 1.4 ± 1.1 | 1.2 ± 0.9 | 0.03b |
| Post-hCG E2 absolute difference (pg/ml) | 1034 ± 882 | 49 ± 178 | −555 ± 446 | 0.0001a,†,b,†,c,† |
| Post-hCG E2 percent difference (%) | 35.1 ± 28.7 | 1.6 ± 5.4 | −17.0 ± 6.8 | 0.0001a,†,b,†,c,† |
| Number of oocytes retrieved | 12.5 ± 6.8 | 11.0 ± 6.2 | 11.8 ± 6.8 | 0.0001a,† |
| Micromanipulation | ||||
| ICSI (%) | 22.3 | 18.9 | 23.0 | 0.26 |
| Assisted hatching (%) | 30.6 | 40.8 | 32.0 | <0.0001a,† |
| IVF cycle outcomes | ||||
| Cycles with embryos cryopreserved (%) | 29.5 | 22.1 | 25.4 | 0.007a |
| Number of embryos cryopreserved | 1.8 ± 3.5 | 1.5 ± 3.2 | 1.5 ± 3.0 | 0.005a |
| Number of embryos transferred | 2.7 ± 1.0 | 2.8 ± 1.1 | 2.7 ± 1.1 | 0.13 |
| Cycles without embryo transfer (n, %) | 97 (9.1) | 55 (10.5) | 14 (11.5) | 0.54 |
| Clinical outcomes per cycle | ||||
| Number of fetal heart tones (FHTs) | 1.2 ± 0.7 | 1.3 ± 0.7 | 1.2 ± 0.8 | 0.28 |
| Implantation(%) | 20.7 | 16.2 | 14.1 | 0.002a,†,b |
| Clinical intrauterine pregnancy (%) | 38.4 | 28.0 | 23.3 | <0.001a,†,b,† |
| Spontaneous abortion (%) | 19.7 | 18.7 | 31.8 | 0.55 |
| Live birth (%) | 27.6 | 19.3 | 12.5 | <0.001a,†,b,† |
| Multiple gestations per delivery (%) | 31.2 | 36.0 | 35.8 | 0.57 |
- Note: values are the mean ± SD unless otherwise noted.
- aGroup A significantly different from Group B, P < 0.05.
- bGroup A significantly different from Group C, P < 0.05.
- cGroup B significantly different from Group C, P < 0.05.
- †P value ≤ 0.001.
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