卵巢低反应人群应用高孕酮状态下促排卵方案中地屈孕酮和醋酸甲羟孕酮的对比:一项倾向性评分匹配队列研究  

Comparison of dydrogesterone and medroxyprogesterone acetate in progestin-primed ovarian stimulation protocol for patients with poor ovarian response:a propensity score matching cohort study

作　　者：杜明泽 张俊韦 于晓娜[1] 李真[1] 管一春[1] Du Mingze;Zhang Junwei;Yu Xiaona;Li Zhen;Guan Yichun(Reproductive Center of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院生殖医学科,郑州450052

出　　处：《中华生殖与避孕杂志》2023年第7期670-675,共6页Chinese Journal of Reproduction and Contraception

基　　金：2021年度河南省医学科技攻关联合共建项目(LHGJ20210451)。

摘　　要：目的比较高孕酮状态下促排卵(progestin-primed ovarian stimulation,PPOS)方案中地屈孕酮和醋酸甲羟孕酮(medroxyprogesterone acetate,MPA)在卵巢低反应(poor ovarian response,POR)人群中的临床应用结局。方法本研究属于单中心回顾性队列研究。纳入2019年1月至2021年9月期间在郑州大学第三附属医院生殖医学科行PPOS方案助孕的POR患者。根据使用的孕激素药物不同,分为地屈孕酮组和MPA组。以1∶3进行倾向性评分匹配(propensity score matching,PSM)校正混杂因素。观察指标为可利用胚胎数、获卵数、双原核(two pronuclei,2PN)数、优质胚胎数、全胚冷冻第一周期移植临床妊娠率和持续妊娠率。结果共纳入1962个周期,其中地屈孕酮组共494个周期,MPA组共1468个周期。两组间不孕因素差异有统计学意义(P=0.045),余基础资料差异均无统计学意义(均P>0.05)。地屈孕酮组的促性腺激素(gonadotropin,Gn)启动量[300(225,300)U]低于MPA组[300(300,300)U,P<0.001]。Gn使用时间、Gn使用总量、早发黄体生成素峰、获卵数、2PN数、可利用胚胎数和优质胚胎数在组间差异均无统计学意义(均P>0.05)。共有1331个周期进行了第1次冻融胚胎移植,其中地屈孕酮组268个周期,MPA组1063个周期。移植日子宫内膜厚度、移植胚胎数、移植胚胎阶段、子宫内膜准备方案组间差异均无统计学意义(均P>0.05)。两组间的临床妊娠率和持续妊娠率差异均无统计学意义(均P>0.05)。结论对于POR患者,PPOS方案中地屈孕酮和MPA可获得相似的临床结局,表明地屈孕酮可作为PPOS方案有效的选择之一。Objective To compare the clinical outcomes of dydrogesterone and medroxyprogesterone acetate(MPA)in the progestin-primed ovarian stimulation(PPOS)protocol for patients with poor ovarian response(POR).Methods This study was a single-center retrospective cohort study.POR patients who underwent PPOS protocol in Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2019 to September 2021 were included for analysis.According to different progestin drugs used,they were divided into dydrogesterone group and MPA group.Propensity score matching(PSM)was performed 1∶3 to correct for confounding factors.Outcome measures were the number of available embryos,oocytes retrieved,two pronuclei(2PN)and high-quality embryos,the clinical pregnancy rate and the continuing pregnancy rate in the first frozen embryo transfer cycle.Results A total of 1962 cycles were included,including 494 cycles in the dydrogesterone group and 1468 cycles in the MPA group.There was a statistically significant difference in infertility factors between the two groups(P=0.045).The other baseline characteristics were not significantly different(all P>0.05).The initiating dosage of gonadotropin(Gn)in the dydrogesterone group[300(225,300)U]was lower than that in the MPA group[300(300,300)U,P<0.001].There were no significant differences in the duration and total dosage of Gn used,premature luteinizing hormone surge rate,the number of oocytes retrieved,the number of 2PN,the number of available embryos and the number of good-quality embryos between the two groups(all P>0.05).A total of 1331 cycles underwent the first frozen-thawed embryo transfer,including 268 cycles in the dydrogesterone group and 1063 cycles in the MPA group.There were no significant differences in endometrial thickness on the day of embryo transfer,the number of transferred embryos,the stage of transferred embryos,and the endometrial preparation protocols between the two groups(all P>0.05).There were no significant differences in the clinical pregnancy rat

关 键 词：地屈孕酮 醋酸甲羟孕酮 高孕酮状态下促排卵 临床妊娠率 

分 类 号：R714.8[医药卫生—妇产科学]