黄体期添加经皮雌激素对卵巢高反应人群体外受精-胚胎移植妊娠结局的影响

Effect of transdermal estrogen for luteal support in ovarian hypersensitivity patients undergoing IVF

目的探讨卵巢高反应人群在黄体期添加经皮雌激素后对IVF-ET妊娠结局的影响。方法前瞻性研究2016年8月至2017年1月在南京大学医学院附属鼓楼医院生殖医学中心行IVF-ET鲜胚移植的卵巢高反应患者257例的临床资料,按随机数字表将其分成两组:单纯P组(116例),从取卵日开始给予地屈孕酮+雪诺同行黄体支持;E2+P组(141例),移植前地屈孕酮+雪诺同使用方法同单纯P组,移植后第7天开始经皮给予雌激素1周。比较两组患者的促排卵情况和妊娠结局。结果两组患者的一般资料比较均无显著性差异(P>0.05);两组的HCG日E2、P水平、内膜厚度,获卵数,移植胚胎数及优质胚胎数等比较均无显著性差异(P>0.05);两组患者的临床妊娠率(75.9%vs.74.5%)、持续临床妊娠率(71.6%vs.68.1%)、自然流产率(4.6%vs.8.6%)及异位妊娠率(1.1%vs.0%)等亦无显著性差异(P>0.05)。E2+P组的中重度OHSS发生率略高于单纯P组,但无显著性差异(P=0.297)。结论卵巢高反应人群在黄体期添加经皮雌激素不能显著提高临床妊娠率,而中重度OHSS发生率有上升趋势,因此对于卵巢高反应人群不推荐在新鲜胚胎移植后补充经皮雌激素。

A total of257high responders for IVF-ET treatment in Reproductive Medicine Center of Drum Tower Hospital Affiliated to Nanjing University Medical School from August2016to January2017were randomly assigned into two groups:the patients were given dydrogesterone20mg bid.+progesterone vaginal gel(Crinone8%)90mg qd.in P-only group(n=116);the patients were given dydrogesterone20mg bid.+progesterone vaginal gel90mg qd.+transdermal estrogen1.5mg bid.7days after transplantation for1weeks in E2+P group(n=141).Results:There were no significant differences in the levels of E2&progesterone on HCG day,endometrium thickness on HCG day,number of oocytes retrieved,number of good-quality embryos,number of transferred embryos per cycle between P-only group and E2+P group(P>0.05).Furthermore,clinical pregnancy rate(75.9%vs.74.5%),ongoing clinical pregnancy rate(71.6%vs.68.1%),miscarriage rate(4.6%vs.8.6%)and ectopic pregnancy rate(1.1%vs.0%)also had no significant difference between the two groups(P>0.05).The moderate-severe OHSS rate was slightly higher in E2+P group(8.5%vs.5.2%,P=0.297).Conclusions:Transdermal estrogen luteal support in high responders undergoing IVF-ET can not improve the clinical pregnancy rate.However,the moderate-severe OHSS rate was slightly higher in E2+P group.Therefore,it is not recommended to supplement the transdermal estrogen after fresh embryo transfer for ovarian hypersensitivity patients.