IVF/ICSI-ET周期中两种不同黄体支持方案对妊娠结局的影响  

Effect of two different luteal support protocols in IVF/ICSI-ET cycles on pregnancy outcomes

作　　者：郭沛沛[1] 谭丽[1] 张乐 张丹[1] Guo Peipei;Tan Li;Zhang Le;Zhang Dan(Reproductive Medicine Center,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院生殖医学中心,郑州450000

出　　处：《中国实用医刊》2025年第4期1-5,共5页Chinese Journal of Practical Medicine

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190319)。

摘　　要：目的探讨体外受精-胚胎移植(IVF-ET)或卵母细胞内单精子显微注射-胚胎移植(ICSI-ET)周期中两种不同黄体支持方案对妊娠结局的影响。方法回顾性分析2017年1月至2022年5月在郑州大学第二附属医院生殖医学中心接受IVF-ET或ICSI-ET的3936周期数患者的临床资料,按照接受黄体支持方案的不同将患者分为A组与B组,A组(3390周期数)每日经阴道行黄体酮软胶囊(安琪坦)治疗,0.3 g/次,2次/d;B组(546周期数)每日经阴道行黄体酮阴道缓释凝胶(雪诺酮)治疗,0.09 g/次,1次/d。两组均联合地屈孕酮口服,0.02 g/次,2次/d。两组均在孕10周左右逐渐减量,至孕12周左右停药。结果两组患者临床妊娠率、异位妊娠率、早期流产率比较差异未见统计学意义(P>0.05);A组孕12周持续妊娠率(56.50%,1916/3390)高于B组(52.00%,284/546),差异有统计学意义(P<0.05)。进一步的Logistic回归分析显示,女方年龄、移植胚胎数等是孕12周持续妊娠的独立影响因素,而黄体支持方案不是孕12周持续妊娠的独立影响因素。结论在IVF/ICSI-ET周期中,黄体酮软胶囊阴道用药(0.3 g/次,2次/d)联合地屈孕酮与黄体酮阴道缓释凝胶阴道给药(0.09 g/次,1次/d)联合地屈孕酮片相比,能够取得类似的妊娠结局。ObjectiveTo investigate the effect of two different luteal support protocols in in vitro fertilization-embryo transfer(IVF-ET)or intracytoplasmic sperm injection-embryo transfer(ICSI-ET)cycles on pregnancy outcomes.MethodsA retrospective analysis was conducted on the clinical data of 3936 cycles of patients who underwent IVF-ET or ICSI-ET in the Reproductive Medicine Center of the Second Affiliated Hospital of Zhengzhou University from January 2017 to May 2022.The patients were divided into the group A and the group B based on the luteal support protocol.Group A(3390 cycles)received daily transvaginal treatment with progesterone soft capsules(utrogestan)at a dose of 0.3 g per administration,twice daily;group B(546 cycles)received daily transvaginal treatment with progesterone sustained-release vaginal gel(crinone)at a dose of 0.09 g per administration,once daily.Both groups were also treated with oral dydrogesterone at a dose of 0.02 g per administration,twice daily.Both groups gradually reduced the dosage around 10 weeks of pregnancy,and discontinued the medication around 12 weeks of pregnancy.ResultsThere was no statistically significant difference in clinical pregnancy rate,ectopic pregnancy rate,and early abortion rate between the two groups(P>0.05).The continuous pregnancy rate at 12 weeks in group A was 56.50%(1916/3390),higher than the 52.00%(284/546)of group B(P<0.05).Further logistic regression analysis revealed that maternal age and the number of transferred embryos were independent factors affecting ongoing pregnancy at 12 weeks,while luteal support protocol was not an independent factor affecting ongoing pregnancy at 12 weeks.ConclusionsIn the IVF-ET or ICSI-ET cycles,progesterone soft capsules for vaginal administration(0.3 g/time,2 times/d)combined with dydrogesterone can achieve similar pregnancy outcomes compared with progesterone sustained-release vaginal gel for vaginal administration(0.09 g/time,1 time/d)combined with dydrogesterone.

关 键 词：体外受精 卵母细胞内单精子显微注射 胚胎移植 黄体酮软胶囊 黄体酮阴道缓释凝胶 地屈孕酮 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]