促排卵周期胚胎移植后黄体支持药物减量时间对妊娠结局的影响
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摘要
目的探讨IVF/ICSI-ET周期中黄体支持维持的时间对临床妊娠结局的影响。方法回顾性分析2016年1～12月在兰州大学第一医院生殖医学专科医院行IVF/ICSI-ET助孕并获得临床妊娠的患者的临床资料,并根据黄体支持减药方案的不同分为2组:常规减药组(304例),在胚胎移植术后65～70d开始减药;早期减药组(296例),在移植后35～42d开始减药。比较两组患者的一般资料、早期胚胎停育率、孕中期流产率、早产率以及活产率等。结果两组患者的一般资料比较无显著性差异(P>0.05)。早期减药组与常规减药组的获卵数、MⅡ卵率、2PN率、卵裂率、优质胚胎率比较均没有显著性差异(P>0.05);早期减药组与常规减药组的早期胚胎停育率(11.82%vs.12.17%)、孕中期流产率(3.04%vs.5.26%)、早产率(2.70%vs.3.95%)、活产率(82.43%vs.80.59%)比较亦没有显著性差异(P>0.05)。结论 IVF/ICSI助孕周期中,胚胎移植术后早期开始减少黄体酮用量对临床妊娠结局没有显著影响。
Objective:To explore the effects of maintenance time of luteal support on clinical pregnancy outcomes in IVF.Methods:The clinical data of patients who received IVF/ICSI-ET assisted pregnancy and obtained clinical pregnancy in the First Hospital of Lanzhou University from January to December 2016 were retrospectively analyzed.According to the different corpus luteum support reduction protocols,they were divided into two groups:the conventional drug reduction group(n=304),which started to reduce the drug65-70 days after the embryo transfer;the early drug reduction group(n=296),which started to reduce the drug 35-42 days after the transplantation.The general data,early embryonic arrest rate,mid-pregnancy abortion rate,preterm birth rate,and live birth rate were compared between the two groups.Results:There was no significant difference in the general data between the two groups(P>0.05).There was no significant difference in the number of oocytes,MⅡoocytes rate,2 PN rate,cleavage rate andhigh quality embryo rate between the early drug reduction group and the conventional drug reduction group(P>0.05).Early embryonic arrest rate(11.82% vs.12.17%),mid-pregnancy abortion rate(3.04% vs.5.26%),the preterm birth rate(2.70% vs.3.95%),and the live birth rate(82.43% vs.80.59%)were not significantly different between the two groups(P>0.05).Conclusions:Early reduction of amount of progesterone after IVF-ET has no effect on clinical pregnancy outcome.
Objective:To explore the effects of maintenance time of luteal support on clinical pregnancy outcomes in IVF.Methods:The clinical data of patients who received IVF/ICSI-ET assisted pregnancy and obtained clinical pregnancy in the First Hospital of Lanzhou University from January to December 2016 were retrospectively analyzed.According to the different corpus luteum support reduction protocols,they were divided into two groups:the conventional drug reduction group(n=304),which started to reduce the drug65-70 days after the embryo transfer;the early drug reduction group(n=296),which started to reduce the drug 35-42 days after the transplantation.The general data,early embryonic arrest rate,mid-pregnancy abortion rate,preterm birth rate,and live birth rate were compared between the two groups.Results:There was no significant difference in the general data between the two groups(P>0.05).There was no significant difference in the number of oocytes,MⅡoocytes rate,2 PN rate,cleavage rate andhigh quality embryo rate between the early drug reduction group and the conventional drug reduction group(P>0.05).Early embryonic arrest rate(11.82% vs.12.17%),mid-pregnancy abortion rate(3.04% vs.5.26%),the preterm birth rate(2.70% vs.3.95%),and the live birth rate(82.43% vs.80.59%)were not significantly different between the two groups(P>0.05).Conclusions:Early reduction of amount of progesterone after IVF-ET has no effect on clinical pregnancy outcome.
引文
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[5]Edwards RG,Steptoe PC,Purdy JM.Establishing full-term human pregnancies using cleaving embryos grown in vitro[J].Br J Obstet Gynaecol,1980,87:737-756.
[6]Kerin JF,Broom TJ,Ralph MM,et al.Human luteal phase function following oocyte aspiration from the immediately preovular graafian follicle of spontaneous ovular cycles[J].Br J Obstet Gynaecol,1981,88:1021-1028.
[7]Smitz J,Devroey P,Faguer B,et al.A randomized prospective study comparing supplementation of the luteal phase and early pregnancy by natural progesterone administered by intramuscular or vaginal route[J].Rev Fr Gynecol Obstet,1992,87:507-516.
[8]Smitz J,Erard P,Camus M,et al.Pituitary gonadotrophin secretory capacity during the luteal phase in superovulation using GnRH-agonists and HMG in a desensitization or flareup protocol[J].Hum Reprod,1992,7:1225-1229.
[9]Miyake A,Aono T,Kinugasa T,et al.Suppression of serum levels of luteinizing hormone by short-and long-loop negative feedback in ovariectomized women[J].J Endocrinol,1979,80:353-356.
[10]Elter K,Nelson LR.Use of third generation gonadotropinreleasing hormone antagonists in in vitro fertilization-embryo transfer:a review[J].Obstet Gynecol Surv,2001,56:576-588.
[11]Bar-Hava I,Mizrachi Y,Karfunkel-Doron D,et al.Intranasal gonadotropin-releasing hormone agonist(GnRHa)for lutealphase support following GnRHa triggering,a novel approach to avoid ovarian hyperstimulation syndrome in high responders[J].Fertil Steril,2016,106:330-333.
[12]陈峥屹,蒋励,沈浣.体外受精-胚胎移植的黄体期支持[J].生殖医学杂志,2018,27:718-724.
[13]Andersen CY,Fischer R,Giorgione V,et al.Micro-dose hCGas luteal phase support without exogenous progesterone administration:mathematical modelling of the hCGconcentration in circulation and initial clinical experience[J].J Assist Reprod Genet,2016,33:1311-1318.
[14]Segal L,Breyzman T,Kol S.Luteal phase support post IVF:individualized early stop[J/OL].Reprod Biomed Online,2015,31:633-637.
[15]de Ziegler D,Pirtea P,Andersen CY,et al.Role of gonadotropin-releasing hormone agonists,human chorionic gonadotropin(hCG),progesterone,and estrogen in luteal phase support after hCG triggering,and when in pregnancy hormonal support can be stopped[J].Fertil Steril,2018,109:749-755.
[16]Schmidt KL,Ziebe S,Popovic B,et al.Progesterone supplementation during early gestation after in vitro fertilization has no effect on the delivery rate[J].Fertil Steril,2001,75:337-341.
[17]Nyboe AA,Popovic-Todorovic B,Schmidt KT,et al.Progesterone supplementation during early gestations after IVF or ICSI has no effect on the delivery rates:a randomized controlled trial[J].Hum Reprod,2002,17:357-361.
[18]Vaisbuch E,de Ziegler D,Leong M,et al.Luteal-phase support in assisted reproduction treatment:real-life practices reported worldwide by an updated website-based survey[J/OL].Reprod Biomed Online,2014,28:330-335.
[19]曹羽明,杜二球,张颖,等.辅助生殖过程中不同给药途径进行黄体支持的疗效评价[J].生殖医学杂志,2018,27:327-334.
[20]Khan AM,Jariwala S,Lieman HJ,et al.Acute eosinophilic pneumonia with intramuscular progesterone after in vitro fertilization[J].Fertil Steril,2008,90:1200.e3-6.
[2]Gardner DK,Lane M,Stevens J,et al.Blastocyst score affects implantation and pregnancy outcome:towards a single blastocyst transfer[J].Fertil Steril,2000,73:1155-1158.
[3]Jones GE.Some newer aspects of the management of infertility[J].J Am Med Assoc,1949,141:1123-1129.
[4]Csapo AI,Pulkkinen MO,Wiest WG.Effects of luteectomy and progesterone replacement therapy in early pregnant patients[J].Am J Obstet Gynecol,1973,115:759-765.
[5]Edwards RG,Steptoe PC,Purdy JM.Establishing full-term human pregnancies using cleaving embryos grown in vitro[J].Br J Obstet Gynaecol,1980,87:737-756.
[6]Kerin JF,Broom TJ,Ralph MM,et al.Human luteal phase function following oocyte aspiration from the immediately preovular graafian follicle of spontaneous ovular cycles[J].Br J Obstet Gynaecol,1981,88:1021-1028.
[7]Smitz J,Devroey P,Faguer B,et al.A randomized prospective study comparing supplementation of the luteal phase and early pregnancy by natural progesterone administered by intramuscular or vaginal route[J].Rev Fr Gynecol Obstet,1992,87:507-516.
[8]Smitz J,Erard P,Camus M,et al.Pituitary gonadotrophin secretory capacity during the luteal phase in superovulation using GnRH-agonists and HMG in a desensitization or flareup protocol[J].Hum Reprod,1992,7:1225-1229.
[9]Miyake A,Aono T,Kinugasa T,et al.Suppression of serum levels of luteinizing hormone by short-and long-loop negative feedback in ovariectomized women[J].J Endocrinol,1979,80:353-356.
[10]Elter K,Nelson LR.Use of third generation gonadotropinreleasing hormone antagonists in in vitro fertilization-embryo transfer:a review[J].Obstet Gynecol Surv,2001,56:576-588.
[11]Bar-Hava I,Mizrachi Y,Karfunkel-Doron D,et al.Intranasal gonadotropin-releasing hormone agonist(GnRHa)for lutealphase support following GnRHa triggering,a novel approach to avoid ovarian hyperstimulation syndrome in high responders[J].Fertil Steril,2016,106:330-333.
[12]陈峥屹,蒋励,沈浣.体外受精-胚胎移植的黄体期支持[J].生殖医学杂志,2018,27:718-724.
[13]Andersen CY,Fischer R,Giorgione V,et al.Micro-dose hCGas luteal phase support without exogenous progesterone administration:mathematical modelling of the hCGconcentration in circulation and initial clinical experience[J].J Assist Reprod Genet,2016,33:1311-1318.
[14]Segal L,Breyzman T,Kol S.Luteal phase support post IVF:individualized early stop[J/OL].Reprod Biomed Online,2015,31:633-637.
[15]de Ziegler D,Pirtea P,Andersen CY,et al.Role of gonadotropin-releasing hormone agonists,human chorionic gonadotropin(hCG),progesterone,and estrogen in luteal phase support after hCG triggering,and when in pregnancy hormonal support can be stopped[J].Fertil Steril,2018,109:749-755.
[16]Schmidt KL,Ziebe S,Popovic B,et al.Progesterone supplementation during early gestation after in vitro fertilization has no effect on the delivery rate[J].Fertil Steril,2001,75:337-341.
[17]Nyboe AA,Popovic-Todorovic B,Schmidt KT,et al.Progesterone supplementation during early gestations after IVF or ICSI has no effect on the delivery rates:a randomized controlled trial[J].Hum Reprod,2002,17:357-361.
[18]Vaisbuch E,de Ziegler D,Leong M,et al.Luteal-phase support in assisted reproduction treatment:real-life practices reported worldwide by an updated website-based survey[J/OL].Reprod Biomed Online,2014,28:330-335.
[19]曹羽明,杜二球,张颖,等.辅助生殖过程中不同给药途径进行黄体支持的疗效评价[J].生殖医学杂志,2018,27:327-334.
[20]Khan AM,Jariwala S,Lieman HJ,et al.Acute eosinophilic pneumonia with intramuscular progesterone after in vitro fertilization[J].Fertil Steril,2008,90:1200.e3-6.