不同黄体酮软胶囊剂量对冻胚移植周期妊娠结局的影响

A retrospective study comparing pregnancy outcomes of luteal support protocols in frozen-thawed embryo transfer cycles

目的探讨冻胚移植周期的子宫内膜准备方案中不同黄体酮软胶囊剂量行黄体支持与临床妊娠结局的关系。方法回顾性分析2017年1月至2017年12月中山大学孙逸仙纪念医院采用黄体酮软胶囊行黄体支持的冻胚移植周期853例患者的临床资料,其中自然周期组437例,激素替代周期组416例,按照不同的黄体支持方案分为四组:(1) A组:黄体酮软胶囊400 mg/d;(2) B组:黄体酮软胶囊400 mg/d+地屈孕酮20 mg/d;(3) C组:黄体酮软胶囊600 mg/d;(4) D组:黄体酮软胶囊600 mg/d+地屈孕酮20 mg/d。比较不同子宫内膜准备方案、黄体支持剂量及妊娠结局。结果 (1)自然周期组不同黄体支持方案的临床妊娠率、流产率和活产率比较,差异无统计学意义(P>0.05);(2)激素替代周期C组的临床妊娠率低于D组(35.50%, 51.30%, P=0.008);(3)激素替代周期C组中<35岁患者的早期流产率低于≥35岁患者(7.14%, 36.80%, P=0.004)。C组中,激素替代周期组<35岁患者的临床妊娠率低于自然周期(38.90%, 68.30%, P=0.002)。结论在冻胚移植周期中,激素替代周期增加黄体支持剂量有助于改善患者的妊娠结局。

Objective To compare the pregnancy outcomes of luteal support protocols by methods of endometrium preparation in frozen-thawed embryo transfer cycles. Methods The retrospective study included the frozen-thawed embryo transfer cycles using vaginal micronized progesterone for luteal support in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2017 to December 2017, including 437 patients in the natural cycle group and 416 patients in the hormone replacement cycle group. According to different luteal support programs, they were divided into four groups:(1) Group A: Progesterone soft capsule 400 mg/d;(2) Group B: Progesterone soft capsule 400 mg/d + dydrogesterone 20 mg/d;(3) Group C: Progesterone soft capsule 600 mg/d;(4) Group D: Progesterone soft capsule 600 mg/D + dydrogesterone 20 mg/D. Different endometrial preparation regimens, luteal support dosages and pregnancy outcomes were compared. Results(1) There was no significant difference in the clinical pregnancy rate, abortion rate and live birth rate among different luteal support schemes in the natural cycle group(P > 0.05).(2) The clinical pregnancy rate in group C was lower than that in group D(35.50%, 51.30%, P = 0.008).(3) In group C of hormone replacement cycle, the miscarriage rate of patients < 35 years old was lower than those ≥ 35 years old(7.14%, 36.80%, P = 0.004). In group C, the clinical pregnancy rate of patients < 35 years of age in the hormone replacement cycle group was lower than that in the natural cycle group(38.90%, 68.30%, P = 0.002). Conclusion Enhancing luteal support in artificial cycles would improve the pregnancy outcomes of frozen-thawed cycles.