不同黄体支持方案在冻融胚胎移植中的应用效果比较

摘要

目的 探讨黄体酮阴道缓释凝胶、肌肉注射黄体酮及肌肉注射联合阴道给药三种不同黄体支持方案的不良反应和对冻融胚胎移植(FET)妊娠结局的影响. 方法 回顾性分析在本中心接受FET的患者临床资料,共914个周期.根据患者使用的黄体支持方案,分为3组:A组295个周期,使用黄体酮阴道缓释凝胶;B组313个周期,采用黄体酮针剂肌肉注射;C组306个周期,采用黄体酮针剂加阴道用安琪坦.比较3种黄体支持方案患者的药物不良反应和妊娠结局. 结果 A组药物不良反应显著低于其他两组(P＜0.01);A、B、C 三组的临床妊娠率(分别为51.86％、51.44％、50.98％)、胚胎种植率(分别为35.84％、36.20％、36.47％)、早期出血率(分别为11.12％、10.86％、11.44％)、早期流产率(分别为9.49％、8.62％、9.80％)、异位妊娠率(分别为4.75％、4.79％、4.24％)、多胎妊娠率(分别为15.93％、14.38％、16.01％)、及活产率(分别为38.98％、37.15％、38.56％)组间比较均无统计学差异(P＞0.05). 结论 对于FET患者,选择黄体酮阴道缓释凝胶、肌肉注射黄体酮及肌肉注射联合阴道给药三种方案中的任意一种作黄体支持,都能取得一致的、较好的妊娠结局.黄体酮阴道缓释凝胶使用方便、患者依从性好、不良反应少,在临床中可以单独应用,有较好的应用前景.%Objective:To investigate the adverse reaction and effects of three different luteal support regimens on pregnancy outcomes in frozen-thawed embryo transfer(FET)cycle.Methods:The clinical data of patients undergone FET cycle(n=914)in the reproductive center were analyzed retrospectively.According to the patient's luteal support regimen,the patients were divided into three groups:the patients in group A were given the progesterone sustained-release vaginal ge1(295 cycle);the patients in B group were intramuscularly injected progesterone(313 cycles);the patients in C group were given intramuscular injection progesterone combined administration of vaginal progesterone soft capsules(306 cycles).The adverse reactions and pregnancy outcomes were compared among the three luteal support regimens.Results:The adverse reactions of progesterone sustained-release vaginal gel were less than the other two groups(P＜0.01).There were no significant differences in clinical pregnancy rate(51.86％,51.44％,and 50.98％),implantation rate(35.84％,36.20％,and 36.47％),early bleeding rate(11.12％,10.86％,and 11.44％),early abortion rate(9.49％,8.62％,and 9.80％),ectopic pregnancy rate(4.75％,4.79％,and 4.24％),multiple pregnancy rate(15.93％,14.38％,and 16.01％)and live birth rate(38.98％,37.15％,and 38.56％)among the three groups(P＞0.05).Conclusions:For patients undergoing FET cycle,the three luteal support regimens,i,e.progesterone sustained-release vaginal gel,intramuscular injection of progesterone and intramuscular injection of progesterone combined with vaginal administration of progesterone soft capsules can result in better pregnancy outcomes.Furthermore,the progesterone sustained-release vaginal gel is easy to use with good compliance,fewer adverse reactions,which can be used alone in clinical,and have a good prospect.