不同黄体酮给药方式对辅助生殖治疗妊娠结局的影响

The effects of different progestin therapy on the pregnancy outcome of assisted reproductive technology

目的评价黄体酮阴道缓释凝胶以及注射用黄体酮针剂对辅助生殖治疗效果以及对母婴安全性的影响。方法回顾性分析2012年3月至2016年7月海南医学院第一附属医院妇产科采用辅助生殖技术诊治的200例不孕症患者为研究对象,根据不同黄体酮给药方式将其平均分为观察组和对照组,每组100例患者。观察组和对照组患者黄体支持分别选择黄体酮阴道缓释凝胶与黄体酮针剂肌肉注射。记录两组患者基本妊娠结局、新生儿基本情况、围产期并发症以及分娩后1年子宫内膜容受性改变。结果两组患者基本妊娠结局比较,其差异无统计学意义(P>0.05)。两组新生儿体重、性别、缺陷发生率以及出生后Apgar评分比较,其差异无统计学意义(P>0.05)。两组患者母体围产期并发症比较,其差异无统计学意义(P>0.05)。两组患者入院后人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)日和种植窗日子宫动脉血流脉搏指数(pulse index,PI)、抵抗指数(resistance index,RI)以及内膜下血管化-血流指数(vascularization-blood flow index,VFI)比较,其差异均无统计学意义(均P>0.05);随访1年后,两组患者子宫动脉血流PI、RI与入院时相比均无显著改变,其差异无统计学意义(P>0.05);内膜下VFI均比入院时显著降低,而且观察组患者内膜下VFI显著高于对照组患者,其差异均具有统计学意义(均P<0.05)。结论黄体酮阴道缓释凝胶以及注射用黄体酮针剂都是辅助生殖中安全有效的黄体支持方案,但黄体酮阴道缓释凝胶能够有效保护子宫内膜容受性,减少超促排卵对子宫内膜功能的损伤,值得在临床推广应用。

Objective To evaluate the effect of progesterone vaginal release gel and progesterone injection on the assisted reproductive treatment and maternal and infant safety.Methods A total of 200 patients diagnosed with infertility and conducted assisted reproductive technology with hormone replacement were selected in the First Hospital Affiliated to Hainan Medical University from March 2012 to July 2016.All patients were randomly divided into two groups according to the different administration methods:the observation group(progesterone vaginal sustained release gel+dydrogesterone)and the control group(progesterone injection+dydrogesterone),100 patients each.The basic pregnancy outcomes,perinatal complications,neonatal basic conditions and endometrial receptivity were recorded in the two groups.Results There was no statistically significant difference in pregnancy outcome between the two groups(P>0.05).There was no statistically significant difference in body weight,gender ration,defect rate and Apgar score between the two groups(P>0.05).There was no statistically significant difference in maternal perinatal complications between the two groups(P>0.05).After admission,the difference in the pulse index(PI),resistance index(RI),and vascularization-blood flow index(VFI)between the two groups on the human chorionic gonadotropin(hCG)day and planting window day(all P>0.05).After one-year follow-up,no statistically significant difference was found in uterine arterial blood flow PI and RI from the admission(P>0.05).The VFI were significantly reduced in the two groups and that of the control group was significantly higher than that of the control group(all P<0.05).Conclusions Both the progesterone vaginal release gel and progesterone injection are safe and effective in assisted reproductive technology,and the former can effectively protect the endometrial receptivity and reduce the damage to reproductive function,which is worth popularizing in clinical application.