Clinical Effects of the Follicular Phase Long Regimen and Luteal Phase Long Regimen on Ovulation Induction in IVF-ET Treatment: A Meta-Analysis

Objective:To systematically evaluate the clinical effects of the follicular phase long regimen and the luteal phase long regimen on ovulation induction in IVF-ET treatment.Methods:Databases including PubMed,Embase,Cochrane Library,CNKI,Chinese Biomedical Literature(CBM),VIP,Wanfang,and others were searched up to January 2021.Clinical studies on ovulation induction using the follicular phase long regimen and luteal phase long regimen in IVF-ET treatment were identified.Literature screening,data extraction,and quality evaluation were conducted based on inclusion and exclusion criteria.Meta-analysis was performed using RevMan 5.3 software.Results:After screening,a total of 11 studies were included,comprising 21,544 patients:9,974 in the follicular phase long regimen group and 11,570 in the luteal phase long regimen group.The meta-analysis results were as follows:(1)The number of Gn days and the total amount of Gn in the follicular phase long regimen were higher than those in the luteal phase long regimen(P<0.05);(2)The number of eggs obtained in the follicular phase long regimen was higher than that in the luteal phase long regimen(P<0.05).There were no significant differences in the rate of embryo optimization and cycle cancellation between the two groups(P>0.05);(3)The embryo implantation rate and clinical pregnancy rate in the follicular phase long regimen were higher than those in the luteal phase long regimen(P<0.05),while the abortion rate in the follicular phase long regimen was lower than that in the luteal phase long regimen(P<0.05).Conclusion:Compared to the luteal phase long regimen,the follicular phase long regimen involves more Gn days and a higher total amount of Gn.The optimal embryo rate and cycle cancellation rate were similar between the regimens,but the follicular phase long regimen resulted in more eggs,significantly improved the implantation and clinical pregnancy rates,and reduced the abortion rate.However,these conclusions require further validation through more multicenter,large-sample RCT studies.

Abdominal hemorrhage after peritoneal dialysis catheter insertion:A rare cause of luteal rupture:A case report

BACKGROUND Abdominal hemorrhage is a complication of peritoneal dialysis catheter(PDC)insertion that cannot be neglected,and its causes are mainly related to surgical injury.This article reports a case of massive abdominal hemorrhage that was caused by a rare rupture of corpus luteum shortly after PDC during the initiation of peritoneal dialysis(PD)insertion.CASE SUMMARY A 37-year-old woman was surgically placed a Tenckhoff catheter because of endstage renal disease.On the third postoperative day,the color of the abdominal drainage fluid was pink,and deepened gradually.It turned pale after initiating conservative treatment.On the tenth postoperative day,the color of the abdominal drainage fluid suddenly turned dark red,and the color progressively deepened.The patient’s hemoglobin dropped from 88 g/L to 57 g/L.Abdominal computed tomography(CT)indicated abdominal effusion and a high-density shadow in the abdominal cavity.The surgeon performed a laparotomy and found that the corpus luteum had ruptured on the right side and a left ovarian blood body had formed.The gynecologist repaired the ovary and performed a bilateral oophoroplasty.After the operation,the patient stopped bleeding and hemodialysis was temporarily stopped.PD was resumed after half a month.The patient’s condition improved,and she was discharged 14 d after the laparotomy.CONCLUSION If abdominal hemorrhage occurs in women of childbearing age after PDC insertion,luteal rupture should be considered as the cause.

Expression of Inflammatory Factors in Bovine Reproductive Tract During Follicular and Luteal Phases

In order to improve reproduvtive efficieny and understand reproduvtive defense mechanism, the oviduct, uterine horn and uterine body of bovine were used to detect the changes of inflammatory factors and the relationship between estrogen and progesterone receptor protein during estrous cycle by real-time PCR and Elisa method. The results showed that interleukin-4（IL-4）, interleukin-6（IL-6）, interleukin-10（IL-10）, interleukin-1α（IL-1α） and interleukin-1β（IL-1β） were expressed in cow oviduct, uterine horn and uterine body. In the follicular phase and the luteal phase, m RNA expression of five inflammatory factors in the uterine horn and uterine body was higher than that in the oviduct. In the follicular phase, IL-10 was highly expressed in the uterine horn and uterine body, IL-4 was highly expressed in the uterine horn, uterine body and oviduct. Additionally, in the luteal phase, IL-6 and IL-1β were highly expressed in the uterine horn, uterine body and oviduct, and the highest expression of IL-1β was observed in the uterine horn. The levels of Estrogen Receptor（ERα） protein in the oviduct, uterine horn and uterine body significantly increased in the follicular phase. The levels of Progesterone Receptor（PR） protein in the same portions of the reproductive tract in the luteal phase were significantly higher than those in the follicular phase. IL-4 and IL-10 in the cow reproductive tract might play a major role in the follicular phase, while IL-6 and IL-1β might play a major role in the luteal phase. The expression of five inflammatory factors was not directly regulated by ERα and PR.

The Effect of Gossypol and Misoprostol on Luteal and Decidual Cells in Vitro

Gossypol and Misoprostol could directly damage the luteal and decidual cells cultured in vitro. The LD50 of gossypol alone to luteal and decidual cells were 1.27±0.09 μg/ml and 3.06±0.23 μg/ml, respectively; however when combined with misoprostol (to luteal cells 5μg/ml, or to decidual cells 10μg/ml), the LD50 of gossypol signifcantly decreased to 0.89±0.25 μg/ml and 1.88±0.26 μg/ml, respectively. The LD50 of misoprostol alone to luteal and decidual cells were 14.29±1.29μg/ml and 24.37±4.49 μg/ml, respectively; but it decreased to 8.79±2.18 μg/mland 17.29±1.56 μg/ml, respectively when combined with gossypol (to luteal cells 0.5 μg/ml, or to decidual cells 1.0 μg/ml), also showing statistical difference. The results suggested that the combination of gossypol with misoprostol had synergistic effect on the degeneration of luteal and decidual cells in vitro.

The Effect of Luteal-Phase Support with Triptrolin Administration on Implantation and Clinical Pregnancy Rate in Assisted Reproductive Technology

Background: Luteal phase support with GnRH agonist administration has been shown to be effective in improving the outcome of assisted reproductive technology. The goal of this study was to evaluate the effect of single dose Triptrolin (a GnRH agonist) on the probability of the clinical pregnancy rate following embryo transfer (ET) in assisted reproductive techniques (ART). Methods: In this double blinded randomized clinical trial, 340 infertile women who were candidates for intra-cytoplasmic sperm injection (ICSI) were randomly assigned to receive GnRH agonist (Triptrolin) in the luteal phase or placebo. In the intervention group, 0.1 mg Triptrolin was injected subcutaneously, while the control group received normal saline. The clinical pregnancy and implantation rate were compared between the two groups using chi-2 and t-test. P-values less than 0.05 were considered significant. The registration number of this clinical trial is IRCT 2014030916912N1. Results: Administration of 0.1 mg Triptrolin on day 6 after oocyte pick up showed no superiority over placebo in implantation (16.9% - 14%, P = 0.40) and clinical pregnancy rates (32% - 29%, P = 0.66), but the rate of clinical pregnancy was higher in women who were below 27 years of age and those with PCO. Conclusion: Administration of Triptrolin was not superior to placebo for luteal phase support.

The Clinical Study on Effect of a Combination of Mifepristone with Misoprostol on Late Luteal Fertility Regulation

Objective To investigate the efficacy, safety and acceptability of mifepristone combined with misoprostol used for late luteal fertility regulationMaterials & Methods Sixty-one female volunteers were recruited and there were 261 treatment cycles in total. Subjects were planned to receive treatment with 25 mg of mifepristone, Q12 h × 4 orally for five days prior to expected menstruation followed by 400 μg of misoprostol 48 h later for up to six cycles.Results There were 13 pregnancies in the 267 treatment cycles and among them complete abortion and continuing pregnancy occurred in 7 and 6 cycles respectively. So the overall pregnancy rate was 4. 87% (13/267) and the rate of continuing pregnancy was 2. 25% (6/267) , while the failure rate per pregnant cycle was 46. 15% (6/13). In treatment cycles the vaginal bleeding patterns changed insignificantly as compared with those in control cycles.Conclusion The efficacy, compliance and acceptability of the regimen should be further improved when it was administered for late luteal fertility regulation.

Effects and Interactions of Prostaglandins and Interferon－γ on Steroidogenesis ofHuman Luteal Cells

Previous work from our laboratory has demonstrated that T lymphocyte-derived cytokine,interferon-gamma(IFN-γ) may play a role in human luteal regression by inhibiting luteal progesterone production.Prostaglandin F2αhas been known as an important luteolytic factor in a wide range of mammalian species.It was of interest to investigate the effects of IFN-γon prostaglandin synthesis and their possible interaction with the inhibition on human luteal steroidogenesis.Human luteal cells were cultured for four days in the presence or absence of IFN-γ.Simultaneously, the productions of progesterone,prostaglandin F2α(PGF2α),Prostaglandin E2(PGE2),and 6-ketoprostaglandin F1α(PGF1α) were evaluated.Concomitant with the inhibition of progesterone production induced by IFN-γ,αbiphasic pattern of response of prostaglandin synthesis was observed,i.e.a slight decrease of PGF2αand PGF1αafterα48 h exposure to IFN-γ while an increase of PGE2 after 96 h. In a separate experiment,a luteotropic action of PGE2 and PGF2a on human luteal cells from different stages was observed during 48 and 96 h periods of culture.In addition,while indomethacin(INDO) treatment markedly blocked the prostaglandin synthesis, the hasal as well as hCG stimulated progesterone production was still inhibited by IFN-γas usual.These results suggested that prostaglandins appeared to be not responsible for the observed inhibition Of progesterone production since the inhibitory effect was not influenced by concurrent treatment with INDO which suppressed prostaglandin synthesis.

STUDY ON THE MECHANISM AND EFFECTS OF GLY－TYR－NH_2 AND GLY－TYR－LYS ON RAT LUTEAL CELLS IN VITRO

The action of Gly-Tyr-NH_2, (GY-NH_2) and Gly-Tyr-LYS(GYK) on ￣(125)I-LH binding, cAMP accumulation and progesterone production was investigated. Incubation of rat luteal cells for 2.5 h with GY-NH_2 and GYK at dosage of 0. 2 mmol/L caused a significant inhidition of basal and gonadotropin-stimulated steroidogenesis. GY-NH_2 and GYK were also found to reduce cAMP formation in response to hCG. The activity of adenylate cycles of luteal cells was inhibitd by 0. 2 mmol/LGY-NH_2 and GYK. GY-NH_2 and GYK at a concentration of 0. 2mmol/L were not found to have an inhibitory effect on 8Br-cAMP-stimulated progesterone preduction. GY-NH_2 and GYK did not affect ￣(125)I-LH binding to LH receptors on the luteal cell surface. These results suggest that GY-NH_2 and GYK inhibit steroidogenesis at the step of gonadotropin-stimulated cAMP formation in luteal cells. Adenylate cyclase in luteal cells was also inhibited.

Pregnancy outcomes following supplementation of single dose GnRH agonist to sustain the luteal phase in antagonist fresh embryo transfer cycles:A multicentric prospective cohort study

Objective:To determine whether a single dose of gonadotropin-releasing hormone(GnRH)agonist administered subcutaneously in addition to the regular progesterone supplementation could provide a better luteal support in antagonist protocol fresh embryo transfer cycles.Methods:This prospective,multicentric,cohort study included total 140 women,70 in each group.Controlled ovarian stimulation was carried out as per fixed GnRH antagonist protocol.The trigger was given with hCG.In vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)was performed and day-3 embryos were transferred.Patients were divided into groups 1 and 2 based on computer generated randomization sheet.Six days following oocyte retrieval,group 1 received 0.2 mg decapeptyl subcutaneously in addition to regular progesterone support while group 2 received progesterone only.Luteal support was given for 14 days to both groups;if pregnancy was confirmed luteal support was continued till 12 weeks of gestation.The clinical pregnancy rate was the primary outcome.The implantation rate,miscarriage rate,live birth delivery rate,and multiple pregnancy rates were the secondary outcomes.Results:A total of 140 patients were analysed,70 in each group.Clinical pregnancy rates(47.1%vs.35.7%;P=0.17),implantation rates(23.4%vs.18.1%,P=0.24),live birth delivery rates(41.4%vs.27.1%,P=0.08),and multiple pregnancy rates(21.2%vs.16.0%,P=0.74)were higher in group 1 than in group 2.Group 1 had a lower miscarriage rate than group 2(5.7%vs.8.6%;P=0.75).However,these differences were not statistically significant between the two groups.Conclusions:Administration of a single dose of GnRH agonist in addition to regular natural micronized vaginal progesterone as luteal support in GnRH antagonist protocol cycles marginally improves implantation rates,clinical pregnancy rates,and live birth delivery rates.However,more studies with higher sample sizes are needed before any conclusive statements about GnRH agonist as luteal phase support can be made.

Oral Dydrogesterone versus Vaginal Micronized Progesterone in Luteal Phase Support after Controlled Ovarian Stimulation Using Long Gonadotropin-Releasing Hormone Agonist in Women Undergoing in Vitro Fertilization/Intracytoplasmic Sperm Injection

Background:?Luteal phase support is indicated after Controlled Ovarian Stimulation (COS) using Long Gonadotropin-Releasing Hormone Agonist (GnRHa) protocol in Women undergoing in Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI). Progesterone is widely used for this indication. Objective: The objective of the current trial is to compare both efficacy and safety of oral dydrogesterone and vaginal micronized progesterone in luteal phase support in women undergoing IVF/ICSI using the long GnRHa protocol. Methods: This open-label randomized controlled study conducted at a private fertility and IVF center in Zagazig, Egypt, during the interval between April 2016 and August 2019. The study included women planned to undergo IVF/ICSI for either male factor infertility, tubal factor infertility, or unexplained infertility. Women with pelvic endometriosis, known reduced ovarian reserve, and women who were known to have poor or high response to ovarian stimulation, as well as women who were stimulated using non-long GnRHa protocol were not included. After embryo transfer, eligible women were randomly allocated into one of the two groups: group I, included women who received oral dydrogesterone 10 mg three times per day;and group II, included women who received vaginal micronized progesterone 400 mg twice per day. The primary outcome was live birth rate. The principal secondary outcome was women satisfaction. Results: Five hundred sixty four women were recruited and randomly allocated into two groups: group I [Oral Dydrogesterone Group] (n = 284), and group II [Vaginal Progesterone Group] (n = 280). Live birth rates [72 (25.4%) vs 69 (24.6%), respectively, RR 1.03, 95% CI (0.77 to 1.37)], ongoing pregnancy rates [79 (27.8%) vs 81 (28.9%), respectively, RR 0.96, 95% CI (0.74 to 1.25)], clinical pregnancy rates [97 (34.2%) vs 95 (33.9%), respectively, RR 1.01, 95% CI (0.80 to 1.27)] and miscarriage rates (per clinical pregnancy) [18 (18.6%) vs 14 (14.7%), respectively, RR 1.26, 95% CI (0.66 to 2.38)] were all comparable in both groups. The rates of vaginal burning [4 (1.4%) vs 32 (11.4%), respectively, RR 0.12, 95% CI (0.04 to 0.34)], vaginal bleeding [9 (3.2%) vs 26 (9.3%), respectively, RR 0.34, 95% CI (0.16 to 0.72)] and overall dissatisfaction [15 (5.3%) vs 68 (24.3%), respectively, RR 0.22, 95% CI (0.13 to 0.37)] were significantly lower among women of group I when compared to women of group II. Conclusion: In conclusion, when compared to vaginal micronized progesterone, oral dydrogesterone seems to be associated with comparable live birth, ongoing pregnancy and clinical pregnancy rates, and significantly lower dissatisfaction and side effects rates, when given as luteal phase support in normal responding women undergoing IVF/ICSI using the long GnRHa protocol.

A Systematic Review of the Efficacy and Safety of Didroxyprogesterone Combined with Progesterone in the Treatment of Luteal Insufficiency-Induced Abortion

Objective:To systematically evaluate the efficacy and safety of didroxyprogesterone combined with progesterone in the treatment of luteal insufficiency abortion.Methods:We searched CNKI database,VIP database,Wanfang database,PubMed database,EMBASE database and Cochrane library database for literatures on the treatment of luteal insufficiency-induced abortion with didroxyprogesterone and progesterone.Meta-analysis was performed using Revman 5.3 software after literature extraction and further quality evaluation.Results:Ten randomized controlled trial-related articles that describe studies on a total of 1145 patients,570 in the combination group and 575 in the control group,were included.The results of meta-analysis showed that combination therapy could improve the effective rate of fetal protection(OR=0.14,95%CI[0.07,0.27],P<0.00001).The safety of the combination group was significantly higher than that of the control group(OR=3.09,95%CI[1.13,8.48],P=0.03).Conclusion:To sum up,compared with the control group,the combination of progesterone and progesterone is more effective and safer in the treatment of luteal insufficiency abortion.However,the sample size of the data is relatively small and the quality of the literature is low.This conclusion still needs to be further verified in high-quality randomized controlled trials that involve large samples.

Expression of apoptosis-related genes Fas/FasL, Bax/Bcl-2 and Caspase-3 in rat corpus luteum during luteal regression

Using immunohistochemistry, in situ hybridization, Western blot and TUNEL methods, we have studied the expression of Fas/FasL, Bcl-2/Bax and caspase-3 in the corpora lutea (CL) at various stages of pseudopregnant rat induced by injection of PMSF/hCG. The results showed that no apoptotic signal could be observed until Day 14 after hCG injection. Fas weakly expressed in the CL at all the stages increased when luteolysis took place. FasL signal increased dramatically on Day 14 and reached the maximum level on Day 21. The expression of Bcl-2 and Bax was de-tected in a time-dependent manner. At the early stage of CL development, Bcl-2 expression was stronger, while Bax was low. The expression of Bcl-2 and Bax in the CL was completely reversed. Caspase-3 antigen could be detected throughout all the phases of CL development in a time-dependent fashion, low on Day 2 and reaching the maximum on Day 21. These results sug-gest that luteal regression at the late phases may be related to cell apoptosis.

年轻卵巢储备功能减退患者卵泡期与黄体期应用高孕激素状态超促排卵方案效果比较

目的:比较卵泡期和黄体期启动高孕激素状态超促排卵(PPOS)方案在35岁及以下卵巢储备功能减退(DOR)患者中的应用效果。方法:回顾性分析2018年6月至2021年12月在温州医科大学附属第一医院生殖医学中心采用PPOS方案行体外受精/卵胞质内单精子注射-胚胎移植的483例35岁及以下DOR患者的资料,其中采用卵泡期PPOS方案226例(FPPOS+CC组),黄体期PPOS方案257例(LPPOS+CC组)。比较两组的基线特征、超促排卵结果和实验室相关指标,并比较获得第三天(以下简称D3)优质胚胎的患者超促排卵后第一次冻融胚胎移植的妊娠结局。结果:两组间年龄、不孕年限、继发不孕占比、既往治疗周期数、体重指数、抗米勒管激素、窦状卵泡数、基础黄体生成素、基础孕酮水平、平均获卵数、MⅡ卵率、D3优质胚胎率、深度垂体抑制发生率、活产率和早产率等差异均无统计学意义(均P>0.05)。与FPPOS+CC组比较,LPPOS+CC组诱发排卵日黄体生成素(LH)水平[分别为4.0(2.7,5.3)和5.1(3.2,7.2)IU/L]、早发LH峰发生率(分别为3.13%和10.67%)、卵胞质内单精子注射双原核受精率(分别为72.16%和79.56%)均更低(P<0.05或P<0.01),而促性腺激素(Gn)天数[分别为11(9,12)和9(8,11)d]、Gn总量[分别为2213(1650,2700)和2000(1575,2325)IU]、诱发排卵日孕酮水平[分别为1.3(0.8,2.9)和0.9(0.6,1.2)ng/mL]、冻融胚胎移植的临床妊娠率(分别为61.88%和46.84%)和着床率(分别为42.20%和31.07%)均更高(均P<0.01)。结论:35岁及以下DOR患者采用LPPOS+CC方案后冻融胚胎移植临床妊娠结局更佳。

宫外孕与妊娠黄体囊肿的阴道及腹部超声检查结果分析

目的:分析宫外孕与妊娠黄体囊肿的阴道及腹部超声检查结果。方法:选取2020年12月—2021年12月商丘市第一人民医院收治的64例宫外孕患者和36例妊娠黄体囊肿患者作为研究对象,所有患者均行阴道及腹部超声检查。比较宫外孕及妊娠黄体囊肿患者超声影像学结果。结果:宫外孕组患者RI值和高回声占比高于妊娠黄体囊肿组患者,低回声占比低于妊娠黄体囊肿患者,差异有统计学意义(t=32.149;χ^(2)=24.757,P<0.05);宫外孕组患者极低阻力发生率高于妊娠黄体囊肿组患者,低阻力和高阻力发生率低于妊娠黄体囊肿组患者,差异有统计学意义(χ^(2)=18.688、4.383、5.563,P<0.05);宫外孕组患者点状血流和条状血流占比高于妊娠黄体囊肿组患者,环状及半环状血流占比低于妊娠黄体囊肿组患者,差异有统计学意义(χ^(2)=16.744、18.077、5.806、45.370,P<0.05)。结论:经阴道及腹部超声检查可通过对血流指数、回声、血流分布以及血流频谱形态的差异鉴别宫外孕和妊娠黄体囊肿,以进行及时的鉴别诊断,予以针对性的治疗措施。

黄体期长方案与拮抗剂方案在首次拮抗剂失败后PCOS患者中的应用比较

目的探讨首次拮抗剂治疗失败的多囊卵巢综合征(PCOS)患者再次超促排卵时分别采用黄体期长方案和拮抗剂方案诱导排卵的临床效果及妊娠结局的优劣。方法检索首次采用拮抗剂方案行IVF/ICSI-ET助孕失败后再次超促排卵的PCOS患者163例,根据第二次超促排卵方案,分为黄体期长方案组(共95例)和拮抗剂方案组(共68例)。回顾性分析比较两组患者的基础临床资料、临床及实验室指标及妊娠结局。结果①两组患者的基础临床指标除了LH,其他指标差异均无统计学意义。②黄体期长方案组患者自身超排卵对比,促性腺激素(Gn)启动剂量、Gn总天数、Gn总使用量、hCG注射日雌二醇(E_(2))值、获卵数、卵子成熟率、2PN受精数、2PN卵裂数、囊胚形成率、优质囊胚形成率显著高于首次拮抗剂周期(P<0.05)。拮抗剂方案组患者自身超排卵对比也观察到类似改善。③两组第二次超促排卵周期比较,黄体期长方案组Gn总天数、总用量、总费用较高(P<0.05),而hCG注射日E_(2)及LH水平、卵子成熟率显著低于拮抗剂方案(P<0.05),但两组间获卵数、2PN受精数、2PN卵裂数、囊胚形成率、OHSS率差异无统计学意义。④两组第二次超促排卵新鲜移植周期比较,黄体期长方案新鲜移植率、种植率、临床妊娠率及活产率略高,但差异无统计学意义。首次解冻周期的妊娠结局比较,拮抗剂组的生化妊娠率、临床妊娠率高于黄体期长方案组(P<0.05),但着床率、活产率、新生儿胎龄及出生体质量差异无统计学意义。结论对于首次拮抗剂方案治疗失败的患者,适当增加Gn启动剂量及用量,两种方案均能获得满意的妊娠结局。相较于黄体期长方案,再次使用拮抗剂方案保持了其优势,包括治疗周期短、成本低、患者依从性好。

自拟安胎饮联合黄体酮注射液治疗对黄体功能不足致复发性流产患者子宫动脉血流指标、血清PLGF和CTRP12表达的影响

目的探讨自拟安胎饮联合黄体酮注射液治疗对黄体功能不足致复发性流产(RSA)患者子宫动脉血流指标、血清胎盘生长因子(PLGF)和C1q肿瘤坏死因子相关蛋白12(CTRP12)表达的影响。方法选取2020年1月至2023年8月安徽医科大学附属巢湖医院收治的80例黄体功能不足致RSA患者作为研究对象,随机分为研究组和对照组,每组40例。对照组采用黄体酮注射液治疗,研究组在对照组基础上联合自拟安胎饮治疗,两组均治疗10周。比较两组临床疗效、治疗前后中医肾虚证候积分、子宫动脉血流指标、血清PLGF和CTRP12水平、不良发应发生率。结果研究组治疗总有效率高于对照组(P<0.05)。治疗后,两组各项中医肾虚证候积分均降低,且研究组低于对照组(P<0.05)。治疗后,两组血管指数(VI)降低,血流指数(FI)、血管化血流指数(VFI)升高,且研究组VI低于对照组,FI、VFI高于对照组(P<0.05)。治疗后,两组PLGF和CTRP12水平均升高,且研究组PLGF和CTRP12水平均高于对照组(P<0.05)。研究组不良反应总发生率低于对照组(P<0.05)。结论黄体功能不足致RSA患者采用自拟安胎饮联合黄体酮注射液治疗,可提高临床疗效,改善子宫动脉血流、血清PLGF和CTRP12表达水平。

黄体酮软胶囊不同给药方案用于激素替代冻融胚胎移植黄体支持的临床结局比较

目的比较黄体酮软胶囊不同给药方案进行激素替代冻融胚胎移植中黄体支持的临床疗效。方法对2019年1月至2021年12月期间在中南大学湘雅医院生殖中心行激素替代冻融胚胎移植的3845例患者临床数据进行回顾性分析,纳入的所有患者黄体支持均采用阴道用黄体酮软胶囊联合口服地屈孕酮治疗,根据阴道用黄体酮软胶囊不同用法将其划分为两组:A组每次使用200 mg,每日3次,共1858个周期;B组每次使用300 mg,每日2次,共1987个周期,评估两组的临床治疗效果。结果两组患者在年龄、不孕年限、体质量指数(BMI)、转化日子宫内膜厚度、转化日雌激素(E_(2))水平、转化日孕激素(P)水平、移植优胚占比等方面比较均无显著差异(P>0.05)。A、B两组患者的活产率分别是34.71%(645/1858)和36.39%(723/1987),而移植囊胚的临床妊娠率分别为52.3%(182/348)和55.37%(397/717),两组间比较均无显著性差异(P>0.05)。人绒毛膜促性腺激素(HCG)阳性率、流产率和异位妊娠率等两组间比较也均无显著性差异(P>0.05)。结论冻融胚胎移植激素替代周期中,采用两种不同剂量不同频次的阴道用黄体酮软胶囊治疗作为黄体支持,能够达到相似的临床疗效。

滋清汤治疗黄体功能不足所致月经先期临床观察

目的评价王成荣经验方滋清汤治疗黄体功能不足所致月经先期的临床疗效。方法将60例黄体功能不足性月经先期患者随机分为治疗组和对照组各30例,治疗组予月经周期第5天起口服滋清汤12剂,对照组予基础体温上升1 d起口服地屈孕酮片。2组均治疗3个月经周期,观察2组治疗前后月经提前天数、基础体温高温相维持天数、HPS评分、中医证候积分、黄体期中期孕酮值的情况。结果治疗组总有效率高于对照组;2组治疗后月经提前天数明显降低、基础体温高温相时间均延长(P<0.05);治疗组治疗后中医症状积分低于对照组(P<0.05);治疗组治疗后黄体中期孕酮值、HPS评分高于对照组(均P<0.05)。结论滋清汤治疗黄体功能不足性所致月经先期疗效确切。

五子衍宗丸对黄体功能不全不孕(肾精亏虚)患者的治疗效果观察

目的探讨五子衍宗丸对黄体功能不全不孕(肾精亏虚)患者的治疗效果。方法选取衡水市第二人民医院2020年2月至2022年1月收治的120例黄体功能不全不孕(肾精亏虚)患者,采用随机数字表法分为观察组和对照组,各60例。对照组予以地屈孕酮治疗,观察组予以地屈孕酮联合五子衍宗丸治疗。比较两组治疗前后症状评分、疗效、治疗前后内分泌和代谢指标、安全性及妊娠成功率。结果治疗后两组主症、次症评分与总分均降低且观察均较低(P<0.05);观察组总有效率高于对照组(P<0.05);治疗后两组血清孕酮(P)、黄体生成素(LH)、卵泡刺激素(FSH)、雌二醇(E_(2))水平,以及高温相持续时间(HTPD)、高低温差(HLTD)、基础体温曲线高温相评分(HPS)均升高,且观察组均较高(P<0.05);两组移行天数均减少且观察组较少(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05);观察组妊娠成功率高于对照组(P<0.05)。结论对黄体功能不全不孕(肾精亏虚)以五子衍宗丸联合地屈孕酮治疗可减轻症状、增强效果、改善内分泌及代谢状态,安全性高,且能显著提高妊娠成功率。

卵泡期长效长方案与黄体期短效长方案的临床结局比较

比较体外受精-胚胎移植(IVF-ET)卵泡期长效长方案与黄体期短效长方案新鲜移植周期的临床结局。方法回顾性分析2018年1月至2022年12月在烟台市烟台山医院生殖医学中心行IVF-ET助孕的313例患者(313个周期)资料,根据其促排卵方案分成两组。卵泡期长效长方案组(A组,141个周期),年龄(31.59±3.00)岁,不孕年限(3.48±2.38)年;黄体期短效长方案组(B组,172个周期),年龄(31.42±3.03)岁,不孕年限(3.38±2.38)年。应用t检验及χ^(2)检验比较两种方案的临床结局。结果A组总促性腺激素(Gn)用量、Gn天数、人绒毛膜促性腺激素(HCG)日内膜厚度均高于B组[(29.53±11.18)支比(23.83±7.03)支、(9.61±1.80)d比(8.44±1.26)d、(1.13±0.23)cm比(1.06±0.26)cm],差异均有统计学意义(t=5.49、6.75、2.44,均P<0.05);A组HCG日雌二醇(E2)、HCG日黄体生成素(LH)水平、获卵率、优胚率均低于B组[(2255.00±1417.75)ng/L比(2787.01±1285.11)ng/L、(1.56±1.34)mIU/ml D0I:10.3765.2024.09.015比(2.12±1.02)mIU/ml、81.00%(1522/1879)比84.74%(2043/2411)、38.31%(344/898)比48.22%(597/1238)],差异均有统计学意义(t=3.44、4.14,χ^(2)=10.50、20.76,均P<0.05);A组临床妊娠率、胚胎着床率高于B组[59.65%(68/114)比43.88%(43/98)、44.39%(87/196)比31.82%(56/176)],差异均有统计学意义(χ^(2)=5.26、6.19,均P<0.05)。结论卵泡期长效长方案新鲜移植周期临床妊娠率和胚胎着床率均高于黄体期短效长方案。