HCG日孕酮水平与移植日子宫内膜类型对体外受精-胚胎移植患者妊娠结局的影响OA

Objectives:To investigate the impact of serum progesterone levels on the day of human chorionic gonadotropin(HCG)administration and the endometrial type on embryo transfer day on pregnancy outcomes in fresh cycles of in vitro fertilization-embryo transfer(IVF-ET). Methods:A retrospective analysis was conducted on 1 172 fresh transfer cycles undergoing IVF-ET at the Reproductive Medicine Center of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital from October 2018 to May 2024.A restricted cubic spline(RCS)model was used to evaluate the nonlinear association between progesterone levels on the day of HCG administration and pregnancy outcomes.A threshold value for progesterone levels on HCG day was identified.Based on this threshold,participants were categorized into two groups:those with progesterone levels＜3.18 nmol/L(728 cycles)and those with levels ≥ 3.18 nmol/L(444 cycles).The baseline characteristics,ovulation induction parameters,and pregnancy outcomes of two groups were compared.Patients were classified into three groups according to the endometrial type on embryo transfer day:Type A group(327 cycles),Type B group(459 cycles)and Type C group(386 cycles).Pregnancy outcomes were compared across the three groups.And multivariable logistic regression analysis was conducted to identify clinical factors significantly associated with live birth rate. Results:The results of the RCS showed a significant nonlinear relationship between progesterone levels on the day of HCG administration and the rates of clinical pregnancy and live birth in the fresh cycle(P＜0.05),and the analysis identified a threshold progesterone level of 3.18 nmol/L on HCG day.Compared to the ≥3.18 nmol/L group,the＜3.18 nmol/L group exhibited a significantly higher body mass index(BMI)and the rate of using antagonist protocol for controlled ovarian hyperstimulation(P＜0.05),while no significant difference was observed in endometrial type between the two groups(P＞0.05).The ≥3.18 nmol/L group demonstrated significantly longer duration of gonadotropin(Gn)use,and higher total dose of Gn use,estradiol(E2)level on the day of HCG administration,number of oocytes retrieved,number of cleaved embryos,number of metaphase Ⅱ(MⅡ)oocytes,and number of two-pronuclear(2PN)zygotes when compared with the＜3.18 nmol/L group(P＜0.001).Both the clinical pregnancy rate and live birth rate were significantly lower in the ≥3.18 nmol/L group compared to the＜3.18 nmol/L group(P＜0.001).Within both antagonist and agonist protocols,the live birth rate and clinical pregnancy rate were significantly higher in the＜3.18 nmol/L group than those in the ≥3.18 nmol/L group(P＜0.001).Additionally,the live birth rate of type A group was significantly higher than that of type C group(adjusted P＜0.05).Univariate and multivariate logistic regression analyses identified progesterone level on HCG day,endometrial thickness and endometrial pattern on embryo transfer day,BMI,duration of infertility,number of oocytes retrieved,number of embryos transferred,number of M Ⅱ oocytes,and number of high-quality embryos as significant clinical factors of live birth rate(P＜0.05). Conclusions:For patients aged ≤38 years with ≥3.18 nmol/L of the progesterone level on the day of HCG administration,the clinical pregnancy rate and live birth rate in fresh IVF-ET transfer cycles were significantly reduced.Patients with this profile should prioritize a full embryo freezing strategy.Additionally,type A of endometrium on the day of embryo transfer predicts superior pregnancy outcomes.