口服地屈孕酮片在激素替代治疗-冻融胚胎移植中的效果观察

Effectiveness of Oral Dydrogesterone Tablets during Hormone Replacement Therapy-Frozen Embryo Transfer

目的比较口服地屈孕酮片和阴道用黄体酮凝胶联合口服地屈孕酮片在激素替代治疗-冻融胚胎移植(hormone replacement therapy-frozen embryo transfer,HRT-FET)黄体支持中的临床疗效。方法回顾性分析2018年11月~2022年6月在香港大学深圳医院生殖医学中心实施HRT-FET的患者共489个周期,其中口服地屈孕酮片黄体支持226个周期,阴道用黄体酮凝胶联合口服地屈孕酮片黄体支持263个周期,以活产率为主要观察指标,分析和比较两组HRT-FET的妊娠结局,并对相关因素进行分析。结果两组孕妇的年龄、体重指数、窦卵泡数、卵子总数、月经周期第2天和内膜转化日前1天的血清雌二醇和孕酮水平以及月经周期第2天和内膜转化日前1天的内膜厚度比较,差异无统计学意义(P>0.05);两组患者流产率、异位妊娠率、生化妊娠率、临床妊娠率、活产率及新生儿出生体重比较,差异无统计学意义(P>0.05)。在第2天卵裂期胚胎移植亚组中,两组的流产率、异位妊娠率、生化妊娠率、临床妊娠率、活产率及新生儿体重比较,差异无统计学意义(P>0.05);在第5天囊胚移植亚组中,两组的流产率、异位妊娠率、生化妊娠率、临床妊娠率、活产率比较,差异无统计学意义(P>0.05),单用地屈孕酮片组的新生儿体重显著高于联合用药组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,不同的黄体支持方案对活产率无明显影响(OR=0.703,95%CI:0.461~1.062,P=0.09)。结论HRT-FET后单用口服地屈孕酮片黄体支持与阴道用黄体酮凝胶联合地屈孕酮片的黄体支持比较,其临床妊娠率和活产率差异无统计学意义,单用口服地屈孕酮片可以成为激素替代周期冻融胚胎移植黄体支持的新选择。

Objective To compare the clinical efficacy of luteal phase support with oral dydrogesterone tablets and vaginal progester-one gel combined with oral dydrogesterone tablets during hormone replacement therapy-frozen embryo transfer(HRT-FET).Methods A retrospective analysis was conducted on a total of 489 cycles which underwent HRT-FET at the Center of Reproductive Medicine,the University of Hong Kong-Shenzhen Hospital from November 2018 to June 2022.There were 226 cycles underwent with oral dydrogester-one tablets as luteal support,and 263 cycles underwent with vaginal progesterone gel combined with oral dydrogesterone tablets as luteal support.The primary observation index was the delivery rate.The pregnancy outcomes of HRT-FET in the two groups were compared and analyzed,and the related factors were analyzed.Results There were no significant differences in the age,body mass index,number of antral follicles,total number of eggs,serum levels of estradiol and progesterone on the second day of the menstrual cycle and the day before endometrial transformation between the two pregnant women(P>0.05).There were also no significant differences in the abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate,and neonatal weight between the two groups(P>0.05).In the second day of cleavage stage embryo transfer subgroup,there were no significant diferences in the abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate,and neonatal weight between the two groups(P>0.05),and in the fifth day of blastocyst transfer subgroup,there were also no significant differences in abortion rate,ectopic pregnancy rate,biochemical pregnancy rate,clinical pregnancy rate,delivery rate between the two groups(P>0.05),and in the oral dydrogesterone tablets group,the neonatal weight was significantly higher than that of the vaginal progesterone gel combined with oral dydrogesterone tablets,and the difference was statistically significant(P<0.05).The multivariate Logistic regression analysis showed that different luteal support protocols had no significant impact on the delivery rate(0R=0.703,95%CI:0.461-1.062,P=0.09).Conclusion There were no significant differences between oral dydrogesterone tablets and vaginal progesterone gel combined with oral dydrogesterone tablets in clinical pregnancy rate and delivery rate during HRT-FET.Therefore,the use of oral dydrogesterone tablets alone can be a new option for luteal support in HRT-FET.