两种不同阴道给药黄体支持方案用于激素替代FET周期的临床结局比较
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摘要
目的探讨不同阴道给药黄体支持方案对激素替代治疗(HRT)周期冻融胚胎移植(FET)患者妊娠结局的影响。方法回顾性分析2011年1月至2017年12月在我院生殖中心接受HRT-FET的5 011个周期的临床资料,根据不同的用药情况将纳入对象分为2组:黄体酮阴道缓释凝胶联合地屈孕酮片组(A组,3 049个周期),黄体酮软胶囊联合地屈孕酮片组(B组,1 962个周期)。比较两组患者的基本情况及临床结局。结果两组患者的年龄、体重指数(BMI)、孕酮转化日子宫内膜厚度等基本情况比较,差异均无统计学意义(P>0.05)。A组的胚胎着床率显著高于B组(49.89%vs.47.20%),早期流产率则显著低于B组(7.93%vs.10.49%),差异均有统计学意义(P<0.05);两组的生化妊娠率、临床妊娠率、宫外孕率及多胎率比较,差异均无统计学意义(P>0.05)。结论黄体酮阴道缓释凝胶联合地屈孕酮片和黄体酮软胶囊联合地屈孕酮片两种黄体支持方案应用于HRT-FET患者可以取得相似的临床结局,使用黄体酮阴道缓释凝胶联合地屈孕酮片可以提高胚胎着床率,降低早期流产率。
Objective:To investigate the effect of different vaginal corpus luteum support regimen on pregnancy outcome in hormone replacement therapy(HRT)&frozen-thawed embryo transfer(FET)cycle.Methods:The clinical data of 5 011 HRT-FET cycles in our clinic center from January 2011 to December 2017 were retrospectively analyzed.The cycles were divided into two groups:the patients received a combination of progesterone vaginal sustained-release gel and dydrogesterone in group A(3 049 cycles);the patients received a combination of progesterone soft capsule and dydrogesterone in group B(1 962 cycles).The basic condition and clinical outcomes were compared between the two groups.Results:There were no significant differences in age,BMI and endometrial thickness on progesterone conversion day,etc.between the two groups(P >0.05).The implantation rate in group A were significantly higher than that in group B(49.89% vs.47.20%)(P<0.05),and the early abortion rate in group A were significantly lower than that in group B(7.93% vs.10.49%)(P<0.05).There were no significant differences in the biochemical pregnancy rate,clinical pregnancy rate and ectopic pregnancy rate between the two groups(P>0.05).Conclusions:In the HRT-FET cycles,the similar clinical outcomes can be obtained when the combination of progesterone vaginal sustained-release gel and dydrogesterone or the combination of progesterone soft capsule and dydrogesterone were used for corpus luteum support.However the combination of progesterone vaginal sustained-release gel and dydrogesterone can increase implantation rate and reduce early abortion rate.
Objective:To investigate the effect of different vaginal corpus luteum support regimen on pregnancy outcome in hormone replacement therapy(HRT)&frozen-thawed embryo transfer(FET)cycle.Methods:The clinical data of 5 011 HRT-FET cycles in our clinic center from January 2011 to December 2017 were retrospectively analyzed.The cycles were divided into two groups:the patients received a combination of progesterone vaginal sustained-release gel and dydrogesterone in group A(3 049 cycles);the patients received a combination of progesterone soft capsule and dydrogesterone in group B(1 962 cycles).The basic condition and clinical outcomes were compared between the two groups.Results:There were no significant differences in age,BMI and endometrial thickness on progesterone conversion day,etc.between the two groups(P >0.05).The implantation rate in group A were significantly higher than that in group B(49.89% vs.47.20%)(P<0.05),and the early abortion rate in group A were significantly lower than that in group B(7.93% vs.10.49%)(P<0.05).There were no significant differences in the biochemical pregnancy rate,clinical pregnancy rate and ectopic pregnancy rate between the two groups(P>0.05).Conclusions:In the HRT-FET cycles,the similar clinical outcomes can be obtained when the combination of progesterone vaginal sustained-release gel and dydrogesterone or the combination of progesterone soft capsule and dydrogesterone were used for corpus luteum support.However the combination of progesterone vaginal sustained-release gel and dydrogesterone can increase implantation rate and reduce early abortion rate.
引文
[1]罗轶群,全松.冷冻胚胎移植周期中黄体支持的研究现状[J].国际生殖健康/计划生育杂志,2015,34:339-343.
[2] Roque M,Lattes K,Serra S,et al.Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles:a systematic review and meta-analysis[J].Fertil Steril,2013,99:156-162.
[3] Penzias AS.Luteal phase support[J].Fertil Steril,2002,77:318-323.
[4] Yanushpolsky E,Hurwitz S,Greenberg L,et al.Comparison of Crinone 8%intravaginal gel and intramuscular progesterone supplementation for in vitro fertilization/embryo transfer in women under age 40:interim analysis of a prospective randomized trial[J].Fertil Steril,2008,89:485-487.
[5] Kaser DJ,Ginsburg ES,Missmer SA,et al.Intramuscular progesterone versus 8%Crinone vaginal gel for luteal phase support for day 3cryopreserved embryo transfer[J].Fertil Steril,2012,98:1464-1469.
[6] 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.
[7] Beltsos AN,Sanchez MD,Doody KJ,et al.Patients’administration preferences:progesteronevaginalinsert(Endometrin)compared to intramuscular progesterone for Luteal phase support[J].Reprod Health,2014,11:78.
[8] Lockwood G,Griesinger G,Cometti B,et al.Subcutaneous progesterone versus vaginal progesterone gel for luteal phase support in in vitro fertilization:a noninferiority randomized controlled study[J].Fertil Steril,2014,101:112-119.
[9] Tomic V,Tomic J,Klaic DZ,et al.Oral dydrogesterone versus vaginal progesterone gel in the luteal phase support:randomized controlled trial[J].Eur J Obstet Gynecol Reprod Biol,2015,186:49-53.
[10]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.
[11]迟洪滨,周灿权,王树玉,等.黄体酮阴道缓释凝胶在IVF/ICSI周期中作为黄体支持的初步应用[J].实用妇产科杂志,2012,28:973-976.
[12]许科,陈莉,陈洋,等.黄体酮阴道缓释凝胶在FET周期不同内膜准备方案中黄体支持的效果分析[J].生殖医学杂志,2018,27:232-236.
[13] Wang Y,He Y,Zhao X,et al.Crinone gel for luteal phase support in frozen-thawed embryo transfer cycles:A prospective randomized clinical trial in the Chinese population[J].PLoS One,2015,10:e0133027.
[14] Vaisbuch E,Leong M,Shoham Z.Progesterone support in IVF:is evidence-based medicine translated to clinical practice?A world wide web-based survey[J/OL].Reprod Biomed Online,2012,25:139-145.
[15]龚斐,蔡素芬,卢光琇.两种阴道给药黄体支持药物在IVFET/ICSI后用药的比较研究[J].实用妇产科杂志,2012,28:199-201.
[16] Kleinstein J,Luteal Phase Study Group.Efficacy and tolerability of vaginal progesterone capsules(Utrogest 200)compared with progesterone gel(Crinone 8%)for luteal phase support during assisted reproduction[J].Fertil Steril,2005,83:1641-1649.
[17] Wang LJ,Huang FJ,Kung FT,et al.Comparison of the efficacy of two vaginal progesterone formulations,Crinone8%gel and Utrogestan capsules,used for luteal support in blastocyst stage embryo transfers[J].Taiwan J Obstet Gynecol,2009,48:375-379.
[18]陈燕,沈皓,嵇虹,等.冻融胚胎移植周期阴道用黄体酮的效果评价及对策[J].中国优生与遗传杂志,2015,23,100-102.
[19]方颖,杨晓葵,王树玉.三种黄体支持方案对激素替代周期冻融胚胎移植妊娠结局的影响[J].生殖医学杂志,2015,24:277-280.
[20]何芳,洪名云,唐志霞,等.不同组合黄体支持方案在激素替代冻融胚胎移植中的临床研究[J].中国实用妇科与产科杂志,2015,31:759-762.
[2] Roque M,Lattes K,Serra S,et al.Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles:a systematic review and meta-analysis[J].Fertil Steril,2013,99:156-162.
[3] Penzias AS.Luteal phase support[J].Fertil Steril,2002,77:318-323.
[4] Yanushpolsky E,Hurwitz S,Greenberg L,et al.Comparison of Crinone 8%intravaginal gel and intramuscular progesterone supplementation for in vitro fertilization/embryo transfer in women under age 40:interim analysis of a prospective randomized trial[J].Fertil Steril,2008,89:485-487.
[5] Kaser DJ,Ginsburg ES,Missmer SA,et al.Intramuscular progesterone versus 8%Crinone vaginal gel for luteal phase support for day 3cryopreserved embryo transfer[J].Fertil Steril,2012,98:1464-1469.
[6] 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.
[7] Beltsos AN,Sanchez MD,Doody KJ,et al.Patients’administration preferences:progesteronevaginalinsert(Endometrin)compared to intramuscular progesterone for Luteal phase support[J].Reprod Health,2014,11:78.
[8] Lockwood G,Griesinger G,Cometti B,et al.Subcutaneous progesterone versus vaginal progesterone gel for luteal phase support in in vitro fertilization:a noninferiority randomized controlled study[J].Fertil Steril,2014,101:112-119.
[9] Tomic V,Tomic J,Klaic DZ,et al.Oral dydrogesterone versus vaginal progesterone gel in the luteal phase support:randomized controlled trial[J].Eur J Obstet Gynecol Reprod Biol,2015,186:49-53.
[10]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.
[11]迟洪滨,周灿权,王树玉,等.黄体酮阴道缓释凝胶在IVF/ICSI周期中作为黄体支持的初步应用[J].实用妇产科杂志,2012,28:973-976.
[12]许科,陈莉,陈洋,等.黄体酮阴道缓释凝胶在FET周期不同内膜准备方案中黄体支持的效果分析[J].生殖医学杂志,2018,27:232-236.
[13] Wang Y,He Y,Zhao X,et al.Crinone gel for luteal phase support in frozen-thawed embryo transfer cycles:A prospective randomized clinical trial in the Chinese population[J].PLoS One,2015,10:e0133027.
[14] Vaisbuch E,Leong M,Shoham Z.Progesterone support in IVF:is evidence-based medicine translated to clinical practice?A world wide web-based survey[J/OL].Reprod Biomed Online,2012,25:139-145.
[15]龚斐,蔡素芬,卢光琇.两种阴道给药黄体支持药物在IVFET/ICSI后用药的比较研究[J].实用妇产科杂志,2012,28:199-201.
[16] Kleinstein J,Luteal Phase Study Group.Efficacy and tolerability of vaginal progesterone capsules(Utrogest 200)compared with progesterone gel(Crinone 8%)for luteal phase support during assisted reproduction[J].Fertil Steril,2005,83:1641-1649.
[17] Wang LJ,Huang FJ,Kung FT,et al.Comparison of the efficacy of two vaginal progesterone formulations,Crinone8%gel and Utrogestan capsules,used for luteal support in blastocyst stage embryo transfers[J].Taiwan J Obstet Gynecol,2009,48:375-379.
[18]陈燕,沈皓,嵇虹,等.冻融胚胎移植周期阴道用黄体酮的效果评价及对策[J].中国优生与遗传杂志,2015,23,100-102.
[19]方颖,杨晓葵,王树玉.三种黄体支持方案对激素替代周期冻融胚胎移植妊娠结局的影响[J].生殖医学杂志,2015,24:277-280.
[20]何芳,洪名云,唐志霞,等.不同组合黄体支持方案在激素替代冻融胚胎移植中的临床研究[J].中国实用妇科与产科杂志,2015,31:759-762.