不同组合黄体支持方案在激素替代冻融胚胎移植中的临床研究

Clinical research on different combined luteal phase support in hormone replacement therapy-frozen embryo transfer

目的比较4种不同组合黄体支持方案对激素替代周期冻融胚胎移植(HRT-FET)妊娠结局的影响。方法回顾性分析安徽省妇幼保健院生殖中心2011年1月至2013年1月259周期HRT-FET治疗资料,根据不同的黄体支持方案分为四组,A组:黄体酮针+阴道黄体酮软胶囊(73周期);B组:口服地屈孕酮+阴道黄体酮软胶囊(61周期);C组:黄体酮针+口服黄体酮胶囊(70周期);D组:口服黄体酮胶囊+阴道黄体酮软胶囊(55周期)。分别比较四组资料的临床妊娠率、早期流产率、着床率、活产率、阴道流血率及平均黄体支持时间。结果 4组资料临床妊娠率、早期流产率、着床率、活产率比较差异无统计学意义(P>0.05);阴道流血率(A^D组27.4%、13.1%、27.1%、12.7%)、黄体支持时间[A^D组(35.10±24.43)d、(27.59±16.27)d、(35.83±25.80)d、(27.05±15.75)d],A、C组分别与B、D组比较,差异均有统计学意义(P<0.05)。A、C、D组均有不同程度药物副反应,B组无明显不良反应。结论 HRT-FET后黄体支持选择口服地屈孕酮+阴道黄体酮软胶囊更有优势。

Objective To compare the pregnancy outcomes of four different luteal phase support in hormone replacement therapy-frozen embryo transfer（HRT-FET）.Methods Retrospectively analyze 259 infertile women undergoing hormone replacement therapy-frozen embryo transfer,who were divided into four groups according to the different luteal phase support.Group A ：73（progesterone oil via intramuscular injection route and progesterone suppository via vaginal route）; Group B：61 （dydrogesterone via oral route and progesterone suppository via vaginal route ）;Group C：70 （progesterone oil via intramuscular injeetion route and progesterone suppository via oral route）;Group D：55（progesterone suppository via oral route and progesterone suppository via vaginal route）.We compared the clinical pregnancy and early abortion rate , the rate of embryo implantation, live births and vaginal bleeding rate and the mean time of luteal phase support.Results There was no significant difference in clinical pregnancy rate and the rate of early abortion,embryo implantation and live births（P〉0.05）.The vaginal bleeding rate of group A and C was significantly higher than those of other groups（P〈0.05） （A： 27.4% ,B：13.1% ,C：27.1% ,D：12.7% ）.The mean time of luteal phase support of group A and C was significantly higher than those of other groups（P〈0.05） [A：（35.10±24.43）d,B： （27.59± 16.27）d,C：（35.83±25.80）d,D：（27.05 ± 15.75）d].There was no significant difference in the vaginal bleeding rate and mean time of luteal phase support between A and C.There was no significant difference in the vaginal bleeding rate and mean time of luteal phase support between B and D.There were different degrees of drug side effects in group A, C and D.There was no local and systemic adverse reaction in group B.Conclusions In the HRT- FET cycles, oral dydrogesterone and vaginal progesterone suppository for luteal phase support has more advantages.