黄体期补充戊酸雌二醇对体外受精-胚胎移植妊娠结局的影响

The influence of pregnancy outcomes with oestradiol valeratein addition during luteal phase in IVF-ET cycles.

目的探讨黄体期补充6mg/d戊酸雌二醇用于黄体支持对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法采用前瞻性随机对照研究,选择2008年1月至2009年6月中国医科大学附属盛京医院的379个促性腺激素释放激素激动剂(GnRHa)降调节后的常规IVF或卵胞浆内单精子注射(ICSI)周期(标准长方案和短方案),自采卵日起肌注黄体酮40mg/d,自移植日后增加黄体酮肌注至80mg/d。以长方案、短方案以及HCG日血中雌激素水平分组,每组按随机0、6 mg/d戊酸雌二醇口服作为黄体支持又分成两组,比较两组妊娠率。结果长方案患者中使用戊酸雌二醇组妊娠率48.48%,未使用组为42.26%,两组比较P>0.05;短方案患者中使用戊酸雌二醇组妊娠率34.06%,未使用组为39.13%,两组比较差异无统计学意义(P>0.05);HCG日血中雌二醇<3660、3660～7320和>7320pmol/L患者中,使用戊酸雌二醇组和未使用戊酸雌二醇组妊娠率分别为:35.13%和43.58%、41.35%和40.84%、44.30%和39.74%,两组比较差异无统计学意义(P>0.05)。结论6 mg/d戊酸雌二醇用于黄体支持并不能提高IVF或ICSI-ET周期妊娠率。

Objective To evaluate the influence of pregnancy outcomes with 6mg/d of oestradiol valeratein addition during luteal phase in IVF- ET cycles. Methods Prospective, randomized study was conducted to choose three hundred and seventy-nine cycles of IVF or ICSI in vitro fertilization with GnRH-agonist protocol （ standard long and short protocol） ; Since oocyte retrieval injecting progesterone 40mg/d,im. , and increasing to 80mg/d since embryo transfer. The patients were divided into groups according to protocols and oestradiol level on the day of HCG injection. Every group was divided again into two groups, one of which was given 6mg/d of oestradiol valerate. The pregnancy rats were calculated finally. Results The pregnancy rate in long protocol group was 48.48% with 6 mg/d of oestradiol valerate and 42. 26% without oestradiol valerate; The pregnancy rate in short protocol group was 34.06% with 6 mg/d of oestradiol valerate and 39. 13% without oestradiol valerate ,there were no significant differences between all two groups（ P 〉 0. 05 ） ; The pregnancy rates of patients whose oestradiol level on the day of HCG injection were 〈 3660,3660 - 7320 and 〉 7320pmol/L with and without oestradiol addition were 35.13% and 43.58% ,41.35% and 40. 84% ,44. 30% and 39. 74% respectively , there were no differences between two corresponding groups （ P 〉 0. 05 ）. Conclusion 6mg/d of oestradiol valerate addition for luteal supplementation cannot improve pregnancy rate of IVF or ICSI cycles with along GnRH agonist protocol.