IVF COH施打破卵針當天約有5% P4上升>2 ng/mL (5.5% in GnRHa trigger vs. 3.1% in hCG trigger)
P4一旦上升, 不論用HCG或GnRHagonist用於破卵均不利於胚胎著床

Fertil Steril. 2016 May 10. pii: S0015-0282(16)61116-0. doi: 10.1016/j.fertnstert.2016.04.024. [Epub ahead of print]

Is the effect of premature elevated progesterone augmented by human chorionic gonadotropin versus gonadotropin-releasing hormone agonist trigger?

Connell MT1, Patounakis G1, Healy MW1, DeCherney AH2, Devine K3, Widra E3, Levy MJ3, Hill MJ4.

Author information

Abstract

OBJECTIVE:

To compare the effect of P on live birth rate between hCG and GnRH agonist (GnRH-a) trigger cycles.

DESIGN:

Retrospective cohort study.

SETTING:

Large private assisted reproductive technology (ART) practice.

PATIENT(S):

A total of 3,326 fresh autologous ART cycles.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Live birth.

RESULT(S):

A total of 647 GnRH-a trigger cycles were compared with 2,679 hCG trigger cycles. Live birth was negatively associated with P in both the hCG trigger (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52-0.76) and the agonist trigger cohorts (OR 0.56, 95% CI 0.45-0.69). Interaction testing evaluating P and trigger medication was not significant, indicating that P had a similar negative effect on live birth rates in both cohorts. Progesterone ≥2 ng/mL occurred more commonly in GnRH-a trigger cycles compared with hCG trigger cycles (5.5% vs. 3.1%) and was negatively associated with live birth in both the hCG trigger (OR 0.28, 95% CI 0.11-0.73) and agonist trigger cohorts (OR 0.35, 95% CI 0.14-0.90). When P ≥2 ng/mL, the live birth rates were poor and similar in the hCG and GnRH-a cohorts (5.9% vs. 14.2%), indicating that P ≥2 ng/mL had a similar negative effect on live birth in both cohorts.

CONCLUSION(S):

Elevated serum P on the day of hCG was negatively associated with live birth rates in both hCG and GnRH-a trigger cycles.

Published by Elsevier Inc.