黄体酮、地屈孕酮联合GnRH-α对新鲜周期移植成功妊娠结局影响

Effects of progesterone and dydrogesterone combined with gonadotropin-releasing hormone agonist for treating women with fresh-cycle transplantation on their pregnancy outcomes

目的:探究黄体酮、地屈孕酮拮抗剂方案联合促性腺激素释放激素激动剂(GnRH-a)黄体支持治疗对体外受精-胚胎移植新鲜周期移植成功受孕女性妊娠结局的影响。方法:以本院2017年1月-2019年1月收治的188例新鲜周期移植成功受孕女性为研究对象,根据黄体支持治疗方案不同分为组,其中对照组(n=92)给予黄体酮+地屈孕酮拮抗剂方案治疗,观察组(n=96)在对照组基础上加以GnRH-α黄体支持治疗,比较两组黄体支持效果、妊娠期间OHSS发生率、药物不良反应并随访妊娠结局。结果:两组出血率、止血后继续妊娠率比较均无差异(P>0.05);观察组妊娠期间OHSS总发生率(8.3%)、不良反应总发生率(12.5%)与对照组(13.0%、12.0%)均无差异(P>0.05);两组早期流产率、晚期流产率、早产率、活产率和胎儿畸形率比较均无差异(P>0.05)。结论:拮抗剂方案中结合GnRH-α黄体支持治疗可提高黄体支持效果,且不会增加OHSSS发生率,对妊娠结局有一定改善作用。

Objective: To explore the effects of antagonist regimen of progesterone and dydrogesterone combined with luteal support therapy by gonadotropin-releasing hormone agonist(GnRH-a) for treating women with fresh-cycle transplantation on their pregnancy outcomes after pregnancy successfully. Methods: 188 women with successfully pregnancy after fresh-cycle transplantation were selected as the research subjects and were divided into observation group and control group according to the different treatment regimens of luteal support. 92 women in the control group were given antagonist regimen of progesterone and dydrogesterone, and 96 women in the observation group were given luteal support therapy by GnRH-α additionally on the basis of the women in the control group. The effect of luteal support treatment, the incidence rate of OHSS during pregnancy, and the adverse drug reactions rate of the women were compared between the two groups. The pregnancy outcomes of the women in the two groups were followed up. Results: There were no significant differences in the rates of bleeding and pregnancy continuation after hemostasis of the women between the two groups(P>0.05). The total incidence of OHSS during pregnancy(8.3%) and the total incidence of adverse reactions(12.5%) of the women in the observation group had no significantly different from those(13.0% and 12.0%) of the women in the control group(P>0.05). There were no significant differences in the rates of early abortion, late abortion, premature birth, live birth, and fetal malformation of the women between the two groups(P>0.05). Conclusion: The combination of luteal support therapy by GnRH-α in the combined with antagonist regimen of progesterone and dydrogesterone of the women with pregnancy after fresh-cycle transplantation can improve their effect of luteal support without increasing the incidence rate of OHSSS, and which has a certain improvement of their pregnancy outcomes.