黄体期添加经皮雌激素对卵巢高反应人群体外受精-胚胎移植妊娠结局的影响

摘要

Objective:To investigate the effect of transdermal estrogen for luteal support in ovarian hypersensitivity patients undergoing IVF-ET.Methods:A total of 257 high responders for IVF-ET treatment in Reproductive Medicine Center of Drum Tower Hospital Affiliated to Nanjing University Medical School from August 2016 to January 2017 were randomly assigned into two groups:the patients were given dydrogesterone 20 mg bid.+ progesterone vaginal gel(Crinone 8％)90 mg qd.in P-only group(n=116);the patients were given dydrogesterone 20 mg bid.+ progesterone vaginal gel 90 mg qd.+ transdermal estrogen 1.5 mg bid.7 days after transplantation for 1 weeks in E2 +P group(n=141).Results:There were no significant differences in the levels of E2 & progesterone on HCG day,endometrium thickness on HCG day,number of oocytes retrieved,number of good-quality embryos,number of transferred embryos per cycle between P-only group and E2+P group(P＞0.05).Furthermore,clinical pregnancy rate(75.9％ vs.74.5％),ongoing clinical pregnancy rate(71.6％ vs.68.1％),miscarriage rate (4.6％ vs.8.6％)and ectopic pregnancy rate(1.1％ vs.0％)also had no significant difference between the two groups(P＞0.05).The moderate-severe OHSS rate was slightly higher in E2 +P group(8.5％ vs.5.2％,P=0.297).Conclusions:Transdermal estrogen luteal support in high responders undergoing IVF-ET can not improve the clinical pregnancy rate.However,the moderate-severe OHSS rate was slightly higher in E2 + P group.Therefore,it is not recommended to supplement the transdermal estrogen after fresh embryo transfer for ovarian hypersensitivity patients.%目的 探讨卵巢高反应人群在黄体期添加经皮雌激素后对IVF-ET妊娠结局的影响.方法 前瞻性研究2016年8月至2017年1月在南京大学医学院附属鼓楼医院生殖医学中心行IVF ET鲜胚移植的卵巢高反应患者257例的临床资料,按随机数字表将其分成两组:单纯P组(116例),从取卵日开始给予地屈孕酮+雪诺同行黄体支持;E2 +P组(141例),移植前地屈孕酮+雪诺同使用方法同单纯P组,移植后第7天开始经皮给予雌激素1周.比较两组患者的促排卵情况和妊娠结局.结果 两组患者的一般资料比较均无显著性差异(P＞0.05);两组的HCG日E2、P水平、内膜厚度,获卵数,移植胚胎数及优质胚胎数等比较均无显著性差异(P＞0.05);两组患者的临床妊娠率(75.9％ vs.74.5％)、持续临床妊娠率(71.6％vs.68.1％)、自然流产率(4.6％vs.8.6％)及异位妊娠率(1.1％ vs.0％)等亦无显著性差异(P＞0.05).E2 +P组的中重度OHSS发生率略高于单纯P组,但无显著性差异(P=0.297).结论 卵巢高反应人群在黄体期添加经皮雌激素不能显著提高临床妊娠率,而中重度OHSS发生率有上升趋势,因此对于卵巢高反应人群不推荐在新鲜胚胎移植后补充经皮雌激素.