采用长方案促排卵的重复IVF/ICSI周期中扳机日孕酮与雌二醇比值的临床意义OA

Objectives:To investigate the factors influencing the progesterone-to-estradiol ratio(P/E2)on the HCG trigger day in the repeated IVF/ICSI-ET cycle with long protocol for controlled ovarian stimulation(COS),and to evaluate its predictive value for clinical pregnancy outcomes,as well as its clinical significance across multiple treatment cycles. Methods:This retrospective study included 618 cycles from the patients who underwent two or more IVF/ICSI treatments and the last cycle using the long protocol for COS at our center between January 2022 and September 2024.These subjects were categorized into three groups according to the number of repeated cycles:group A(2 cycles,n=237),group B(3 cycles,n=213),and group C(≥4 cycles,n=168).Additionally,patients undergoing their first IVF/ICSI cycle with long protocol for COS during the same period were included as a control group(n=4 402).Baseline characteristics,embryological parameters,and pregnancy outcomes among groups were evaluated.Multiple linear regression analysis was performed to assess the associations between clinical variables and P/E2 ratio on the trigger day.Logistic regression models were applied to evaluate the relationship between P/E2 ratio and clinical pregnancy outcomes in repeated cycle groups and the control group respectively. Results:Compared with that in the control group,the duration of gonadotropin(Gn)administration was significantly shorter,the estradiol(E2)level on the trigger day was significantly higher,and the P/E2 ratio on the trigger day was significantly lower in Group A,B and C(all P＜0.05).There were significant differences(P＜0.05)in the overall comparison of available embryo rate,blastocyst formation rate,and embryo implantation rate among the four groups.Multiple linear regression analysis demonstrated that basal FSH levels(B=-0.034,P=0.025),anti-Müllerian hormone(AMH)levels(B=-0.055,P=0.002),number of retrieved oocytes(B=-0.046,P＜0.001),and endometrial thickness(B=-0.029,P=0.005)were significantly negatively correlated with the P/E2 ratio on trigger day,whereas the duration of Gn administration was significantly positively correlated(B=0.080,P＜0.001).Logistic regression analysis showed that,in the first IVF/ICSI-ET cycle,the P/E2 ratio was an independent predictor of clinical pregnancy rate[OR=0.802,95％CI(0.658,0.976),P=0.027],whereas no significant effect was observed in repeated cycles(P＞0.05).Age and number of available embryos were the main influencing factors for clinical pregnancy in both first and repeated IVF/ICSI cycles(P＜0.05). Conclusions:The P/E2 ratio on the trigger day has certain predictive value for pregnancy outcomes in the first long-protocol IVF/ICSI cycle;however,its predictive value is markedly diminished in repeated cycles.In patients undergoing repeated cycles,pregnancy outcomes may be more strongly affected by ovarian reserve and embryo quality.Therefore,individualized ovarian stimulation and embryo transfer strategies should be developed based on patients' baseline characteristics.