過早黃體化(premature luteinization)定義

過早黃體化(premature luteinization)
打破卵針hCG當天 P4>1-2 ng/ml
超音波顯示: 卵泡壁變厚，卵泡液呈irregular echogenic

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2854984/

Abstract

Premature luteinization (PL) refers to a rise in serum progesterone (P) levels on the day of hCG administration. Most studies used an absolute P level on the day of hCG administration as an indicator of PL, and the cutoff level differed from 0.8 to 2 ng/mL. Some authors defined PL as a P/E2 ratio of >1. There is a marked variation in the incidence (13% to 71%), of PL due to discrepancies in definition, population characteristics and/or treatment protocols. The pathogenesis of PL in COH is still poorly understood. Several hypotheses may be considered to explain this phenomenon: elevation of follicular LH levels, serum accumulation of HCG from HMG, increased LH receptor sensitivity of the granulosa cells to FSH, or poor ovarian response with increased LH sensitivity. The consequences of this premature elevation of serum P on IVF outcome remain controversial. Attempts to prevent COH include: use of Low-dose hCG alone in the late COH stages, flexible antagonist protocol, use of mifepristone, aspiration of a single leading follicle, hCG administration when the levels of serum P exceeded 1.0 ng/mL.

Table 1

Incidence of premature luteinization according to the protocol and definition

Study	Protocol	Definition	Incidence
Silverberg et al., 1991	GnRHa	P>0.9 ng/mL	12.4%
Martinez et al., 2004	GnRHa	P>0.9 ng/mL	52.3%
Edelstein et al. 1990; Silverberg et al. 1991, Fanchin et al. 1993; Givens et al. 1994; Harada et al. 1995; Ubaldi et al. 1995, 1996	GnRHa	P>.8–2 ng/mL	5–35%
Younis et al. 2001; Ou et al. 2007	GnRHa	P/E2>1	41%
Ubaldi et al. 1996	GnRH antagonist	P>1.1 ng/mL	20%
Bosch et al. 2003	GnRH antagonist	P>1.2 ng/mL	38.3%
Sims et al. 1994	Flare up	P>1.0 ng/ml	85%