不同孕激素给药方式对激素替代方案准备内膜冻胚移植后妊娠及分娩结局的影响

Effect of different progesterone administration methods on pregnancy and delivery outcomes after frozen embryo transfer with hormone replacement regimen to prepare the endometrium

目的探讨激素替代方案准备子宫内膜的冷冻胚胎移植(FET)周期中不同孕激素给药方式对妊娠及分娩结局的影响。方法选取接受第1周期冷冻单囊胚移植并使用激素替代方案准备内膜患者3357例,根据孕激素给药方式分为肌内注射黄体酮组(IMP组)749例、口服地屈孕酮联合阴道微粒化黄体酮胶囊组(DYD-VPC组)2249例及口服地屈孕酮联合阴道黄体酮凝胶组(DYD-VPG组)359例。比较三组基本临床特征、孕产期并发症及妊娠分娩结局的差异。结果三组年龄、BMI、不孕年限、未生育、患有原发性不孕症、窦卵泡数、获卵数、FET前子宫内膜厚度、PCOS患者比例、剖宫产史、移植胚胎发育时间等基线资料比较均无统计学差异(P均>0.05)。三组活产率、生化妊娠率、生化妊娠流产率、临床妊娠丢失率等均无统计学差异(P均>0.05);IMP组剖宫产率高于DYD-VPC组和DYD-VPG组(83.42%vs 76.88%vs 73.41%,P<0.05)。三组妊娠期和新生儿并发症如早产、巨大儿、低出生体质量儿、大于胎龄儿、小于胎龄儿、妊娠期高血压疾病和妊娠期糖尿病发生率均无统计学差异(P均>0.05)。多因素Logistic回归分析校正混杂因素后显示,肌内注射黄体酮与剖宫产风险增加相关。结论在激素替代方案准备子宫内膜的冻胚移植周期中,口服地屈孕酮联合阴道用黄体酮的临床妊娠率和活产率与肌内注射黄体酮相同,但剖宫产率降低。

Objective To explore the effects of different progesterone administration methods on pregnancy and de-livery outcomes in frozen embryo transfer(FET)cycles with hormone replacement regimen to prepare the endometrium.Methods A total of 3357 patients who underwent the first cycle of frozen single blastocyst transfer and used hormone re-placement regimen to prepare their endometrium were selected and divided into the intramuscular progesterone group(IMP group)of 749 cases,the oral dydrogesterone combined with vaginal micronized progesterone capsule group(DYD-VPC group)of 2249 cases,and the oral dydrogesterone combined with vaginal progesterone gel group(DYD-VPG group)of 359 cases according to the different administration methods of progesterone.Differences in basic clinical characteristics,maternal complications and pregnancy outcomes were compared among the three groups.Results There were no signifi-cant differences in age,BMI,duration of infertility,being nulliparous,primary infertility,the number of antral follicles,the number of oocytes retrieved,endometrial thickness before FET,the proportion of patients with PCOS,history of caesar-ean section,development time of transferred embryos,or other baseline data among the three groups(all P>0.05).There were no significant differences in live birth rate,biochemical pregnancy rate,biochemical pregnancy abortion rate or clini-cal pregnancy loss rate among the three groups(all P>0.05).The caesarean section rate was higher in the IMP group than in the DYD-VPC and DYD-VPG groups(83.42%vs.76.88%vs.73.41%,all P<0.05).There were no significant dif-ferences in the incidence of pregnancy and neonatal complications such as preterm birth,macrosomia,low birth weight(LBW),large for gestational age(LGA),small for gestational age(SGA),hypertensive disorders of pregnancy(HDP)or gestational diabetes mellitus(GDM)among the three groups(all P>0.05).Multivariate Logistic regression analysis showed that intramuscular progesterone was associated with an increased risk of caesarean section after adjusting for con-founding factors.Conclusion In frozen embryo transfer cycles with hormone replacement regimens to prepare the endo-metrium,oral dydrogesterone combined with vaginal progesterone has the same clinical pregnancy and live birth rates as in-tramuscular progesterone,but the caesarean section rate is lower.