三种黄体支持方案用于激素替代冻融胚胎移植的临床效果比较

Comparison of clinical effects of three luteal support regimens in HRT-FET cycles

目的探讨阴道用黄体酮软胶囊联合口服地屈孕酮、阴道用黄体酮凝胶联合口服地屈孕酮和肌肉注射黄体酮在激素替代冻融胚胎移植(HRT-FET)中的临床效果。方法回顾分析2015年1月至2017年12月广东省妇幼保健院生殖健康与不孕症科冻融胚胎移植共1130周期,按照黄体支持方法分成阴道用黄体酮软胶囊联合地屈孕酮组114周期(A组),阴道用黄体酮凝胶联合地屈孕酮组273周期(B组),肌注黄体酮组743周期(C组),分析三组患者基线资料和临床助孕结局。结果三组患者的女方取卵日年龄、不孕年限、不孕类型、体重指数(BMI)、抗苗勒管激素(AMH)、转化日内膜厚度、黄体酮转化日雌二醇、孕酮和促黄体生成素(LH)水平、移植胚胎个数间比较差异均无统计学意义(P均>0.05)。A组、B组和C组患者的化学妊娠率(分别为70.2%、67.8%和74.3%)、临床妊娠率(分别为60.5%、61.5%和68.2%)、种植率(分别为49.5%、50.6%和54.9%)、早期自然流产率(分别为20.3%、18.5%和21.5%)和活产率(分别为48.2%、50.2%和52.8%)比较差异均无统计学意义(P>0.05)。结论三种黄体支持方案用于HRT-FET周期黄体支持的临床效果相当,阴道用黄体酮联合口服地屈孕酮可替代肌注黄体酮用于黄体支持。

Objective To investigate the clinical effects of vaginal progesterone soft capsule combined with oral dydroprogesterone,vaginal progesterone gel combined with oral dydroprogesterone and intramuscular progesterone for luteal phase support in frozen-thawed embryo transfer cycles with hormone replacement therapy(HRT-FET).Methods A retrospective analysis of 1130 HRT-FET cycles from the Department of Reproductive Health&Infertility,Guangdong Women&Children Hospital was conducted between January 2015 and December 2017.According to the luteal support method,patients were divided into three groups:group A receiving vaginal progesterone soft capsule combined with oral dydroprogesterone was 114 cycles,group B receiving vaginal progesterone gel combined with oral dydroprogesterone was 273 cycles,group C receiving intramuscular progesterone was 743 cycles.The baseline data and clinical outcomes of the three groups were compared.Results There were no significant difference in the age of egg retrieval day,years of infertility,types of infertility,body mass index(BMI),anti-mullierin hormone(AMH),intimal thickness on transformation day,levels of estradiol,progesterone and luteinizing hormone(LH)on luteinizing support day,and the number of embryos transferred among the three groups(all P>0.05).The chemical pregnancy rate(70.2%,67.8%and 74.3%respectively),clinical pregnancy rate(60.5%,61.5%and 68.2%respectively),planting rate(49.5%,50.6%and 54.9%respectively),early abortion rate(20.3%,18.5%and 21.5%respectively)and live birth rate(48.2%,50.2%and 52.8%respectively)of patients had no statistical significance between group A,group B and group C(P>0.05).Conclusions The clinical effects of three kinds of luteal support regimen are comparable in patients undergoing HRT-FET cycle.Vaginal progesterone combined with oral dydroprogesterone can be used as an alternative to intramuscular progesterone for luteal support.