黄体酮联合雌二醇黄体支持方案对自然周期冻融胚胎移植妊娠结局的影响

The influence of progesterone combined with estradiol support on pregnancy outcomes of women after natural cycle frozen-thawed embryo transfer

目的:黄体酮联合雌激素黄体支持方案对自然周期冻融胚胎移植(NC-FET)妊娠结局的影响。方法:回顾性收集2015年7月—2017年12月在本院接受冻融胚胎移植的306例不孕不育患者临床资料,按照治疗方法的不同分为对照组(78例)与观察组(228例),根据雌激素支持剂量的不同将观察组分为低、中、高剂量3个组各76例。对照组给予黄体酮支持,口服黄体酮胶囊及阴道黄体酮软胶囊给药,观察组在对照组基础上联合雌二醇(黄体)支持,分别每天给予补佳乐2mg、4mg、6mg。比较各组患者排卵期血清卵泡刺激素(FSH)、促黄体生成素(LH)、雌二醇(E2)、孕酮(P)水平,移植(ET)日血清P、E2水平及子宫内膜厚度、胚胎移植数目;比较两组胚胎种植率、临床妊娠率、持续妊娠率、早期流产率、异位妊娠率。结果:观察组排卵期E2、P水平,ET日E2水平均高于对照组(P>0.05),但各剂量组间排卵期FSH、LH、E2、P水平,ET日E2、P、子宫内膜厚度、胚胎移植数目及平均移植优质胚胎数、胚胎种植率、临床妊娠率、持续妊娠率、早期流产率、异位妊娠率等无差异(P>0.05)。临床妊娠率、持续妊娠率、活产率、胚胎种植率及新生儿出生体重,以及早期流产率、异位妊娠率等观察组与对照组均无差异(P>0.05)。结论:黄体酮联合雌激素支持方案较单独黄体酮支持对NC-FET妊娠结局影响未见差异。

Objective:To investigate the influence of progesterone combined with estradiol on the pregnancy outcomes of women after natural cycle freeze-thawed embryo transfer(NC-FET).Methods:The clinical data of 306 infertility women who received NC-FET from July 2015 to December 2017 were collected retrospectively.And these women were divided 78 cases in control group and 228 cases in observation group according to the different treatment methods.The women in the observation group were further divided into group A,B and C according to the different estradiol support dose(76 cases in each group).The women in the control group were given progesterone support(oral progesterone capsule and vaginal progesterone soft capsule).The women in the observation group were given estradiol and progesterone support,which included the women in the group A,B,and C were everyday given estradiol valerate tablets 2 mg,4 mg,and 6 mg,respectively.The levels of serum follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2)and progesterone(P)during ovulation,and the levels of serum P and E2,endometrial thickness,and number of embryo transfer on the ET day,and the embryo implantation rate,the clinical pregnancy rate,the persistent pregnancy rate,the early abortion rate,and the ectopic pregnancy rate of the women were compared between the two groups.Results:The E2 and P levels during ovulation,and E2 level on the ET day of the women in observation group were significant higher than those of the women in the control group(P>0.05).There were no significant different in the levels of FSH,LH,E2,and P during ovulation,the levels of E2 and P,the endometrial thickness,the number of embryo transfer on ET day,and the average number of high-quality embryo,and the rates of embryo grow rate,clinical pregnancy,continuous pregnancy,early abortion,and ectopic pregnancy of the women among the groups(P>0.05).There were no significant differences in the rates of clinical pregnancy,continuous pregnancy,live birth,early abortion,ectopic pregnancy,and embryo implantation,and newborn birth weight of the women between the observation group and the control group(P>0.05).Conclusion:Compared with that of progesterone support alone,progesterone combined with E2 support has little effect on pregnancy outcomes of women after NC-FET.