不同黄体支持方法对体外受精-胚胎移植结果的影响

Effect of different luteal support methods on the outcome of in vitro fertilization-embryo transfer

目的研究不同黄体支持方法对体外受精-胚胎移植(IVF-ET)结果的影响,并探讨促性腺激素释放激素类似物(GnRH-a)在黄体支持中的临床效果。方法回顾性分析352个IVF/ICSI-ET周期的资料,其中单用黄体酮125例(A组),口服联合阴道用孕酮107例(B组),在B组基础上于取卵后6天加用一次注射用醋酸曲普瑞林0.1 mg皮下注射120例(C组),比较三组IVF-ET的结果。结果 A组与B组间临床妊娠率、种植率以及验孕日孕酮(P)和促绒毛膜性腺激素(HCG)水平差异无统计学意义(P>0.017);C组的生化妊娠率、临床妊娠率、种植率以及验孕日P和HCG水平显著高于A组和B组,差异有统计学意义(P<0.017);三组间宫外孕、流产率、卵巢过度刺激综合征(OHSS)发生率差异无统计学意义(P>0.05)。结论口服联合阴道用孕酮法的临床效果等同于肌肉注射黄体酮法,但前者使用方便,患者较易接受。而GnRH-a在黄体支持中的新应用显示了其较好的临床效果。

Objective To investigate the effect of different luteal support methods on outcome of in vitro fertilization -embryo transfer and explore the clinical effect of GnRH-αin luteal support treatment .Methods Clinical data of 352 IVF/ICSI-ET cycles were retrospectively analyzed .They were divided into group A ,B and C according to different luteal support treatments .In the group A （ n =125）,progesterone injection alone was used as luteal support .In the group B （n =107）,oral plus vaginal progesterone were used as luteal support.In the group C （n =120）,oral plus vaginal progesterone and GnRH-a were used as luteal support.In the group C,a sub-cutaneous injection of 0.1 mg Diphereline was also performed on the 6th days after abstracting oocyte .The outcome of IVF/ICSI was compared among the three groups .Results There was no statistical difference between the group A and group B in the clinical preg -nancy rate,implantation rate and levels of progesterone and HCG on the day for testing gestation （P〉0.017）.However,all the indexes in the group C were significant higher than that in the group A and B （ P〈0.017 ） .There are no statistical differences among the three groups in ectopic pregnancy rates ,abortion rates and ovarian hyperstimulation syndrome rates .Conclusion The clinical effect of oral plus vaginal progesterone is equal to that of progesterone injection .However,oral plus vaginal progesterone method is more convenient in application and easier to be accepted by patients .In addition,GnRH-αcan improve the treatment outcomes .