不同药物体外受精-胚胎移植的黄体支持比较

Comparison of different routs of progesterone administation as luteal phase support in vitro fertilization

目的探讨体外受精-胚胎移植与激素替代-冻融胚胎移植周期不同黄体支持方案及妊娠早期出血使用不同孕激素类药物止血治疗的效果。方法回顾性分析确定妊娠的体外受精-胚胎移植与激素替代-冻融胚胎移植周期胚胎评分、妊娠早期阴道出血情况、止血治疗后继续妊娠率及妊娠早期流产率。新鲜周期依不同黄体支持及止血方法分为:(1)A组黄体酮针剂加黄体酮胶囊,以黄体酮针剂加量60～80 mg,每日1次,止血;(2)B组黄体酮针剂加地屈孕酮,以地屈孕酮10 mg,每日3次,止血。冻胚周期分:(1)C组黄体酮针剂,增加黄体酮60～80 mg止血;(2)D组黄体酮针剂,以地屈孕酮40 mg,即刻后10 mg,每日3次,止血。结果体外受精-胚胎移植与激素替代-冻融胚胎移植相比,出血率与妊娠早期流产率较低,差别有统计学意义;新鲜周期使用黄体酮胶囊组出血率高于地屈孕酮组,血止后继续妊娠率低于地屈孕酮组,差异无统计学意义;激素替代-冻融胚胎周期使用黄体酮针剂和地屈孕酮止血,地屈孕酮组继续妊娠率略高,但差异无统计学意义。结论地屈孕酮与黄体酮胶囊的黄体支持效果相似,黄体酮针剂与地屈孕酮的止血效果相似。地屈孕酮在止血方面略有优势。黄体支持用药应根据患者的具体情况决定,个体化用药可能更适合临床应用。

Objective To study the effects of different luteal supplementation on in vitro fertilization,frozen embryo transter（FET） and early pregnancy complicated by threatened abortion.Methods Embryo score,bleeding,ongonging pregnant rate and early abortion rate were analyzed retrospectively.IVF cycles were divided into group A progesterone＋vaginal progesterone caps,increasing injection dose 60~80mg to stop vaginal IVF cycles and group B progesterone＋Dydrogesterone,using Dydrogesterone 10 mg every 8 hrs to stop vaginal bleeding.Frozen embryo transter cycles were divided into group C progesterone,increasing injection dose 60~80mg to stop vaginal bleeding and group D progesterone,using Dydrogesterone 40mg followed with 10mg every 8 hrs for vaginal bleeding.Results IVF cycle＇s bleeding and abortion rate of early pregnancy were lower statistically than that of FET cycle.The bleeding rate was higher and the ongonging pregnant rate was lower in the IVF group using vaginal progesterone caps than those in Dydrogesterone group.But the differences were not significant.The ongonging pregnant rate of the group using Dydrogesterone for vaginal bleeding was higher than the one using progesterone injection,but their differences were not significant.Conclusion The effects of luteal supplementation are similar using progesterone caps and Dydrogesterone.The results of using progesterone injection or dydrogesterone to stop vaginal bleeding are similar with dydrogesterone having a little superiority.The selection of medicine should be made by patiens＇ specific status.Personalized medicine may be more suitable for clinical application.