CAJ | 학술논문

目的通过比较自然周期不同黄体支持方案患者特点及冻融胚胎移植(FET)结局,探讨应用地屈孕酮进行黄体支持的临床结局.方法回顾2011年1月至2013年3月北京大学第三医院生殖医学中心自然周期冻胚移植病例,排卵日内膜厚度8 ～12 mm,A型,共2 248治疗周期,其中口服地屈孕酮黄体支持组(1 967周期),肌内注射黄体酮组(281周期);按不孕因素(输卵管因素、多囊卵巢综合征、男方因素、子宫内膜异位症及其他原因不孕)分类,比较各组患者的临床妊娠率、着床率、异位妊娠率、流产率及活产率.结果两组患者年龄、不孕类型、排卵日内膜厚度、平均移植胚胎数等临床特征相似,地屈孕酮组临床妊娠率(43.26％比38.79％)、胚胎着床率(25.76％比21.13％)偏高,流产率偏低(17.27％比22.02％),但差异无统计学意义;异位妊娠率、早产率、活产率相似.按不孕因素分组,应用地屈孕酮对单纯输卵管因素患者能显著减低的流产率(16.54％比29.55％,P＜0.05)和显著增高的临床妊娠率(43.78％比34.38％,P＜0.05)、活产率(34.16％比23.44％.P＜0.05).结论口服地屈孕酮黄体支持在自然周期FET存在优势,尤其在单纯输卵管因素不孕患者.
목적 통과비교자연주기불동황체지지방안환자특점급동융배태이식(FET)결국,탐토응용지굴잉동진행황체지지적림상결국.방법 회고2011년1월지2013년3월북경대학제삼의원생식의학중심자연주기동배이식병례,배란일내막후도8 ～12 mm,A형,공2 248치료주기,기중구복지굴잉동황체지지조(1 967주기),기내주사황체동조(281주기);안불잉인소(수란관인소、다낭란소종합정、남방인소、자궁내막이위증급기타원인불잉)분류,비교각조환자적림상임신솔、착상솔、이위임신솔、유산솔급활산솔.결과 량조환자년령、불잉류형、배란일내막후도、평균이식배태수등림상특정상사,지굴잉동조림상임신솔(43.26％비38.79％)、배태착상솔(25.76％비21.13％)편고,유산솔편저(17.27％비22.02％),단차이무통계학의의;이위임신솔、조산솔、활산솔상사.안불잉인소분조,응용지굴잉동대단순수란관인소환자능현저감저적유산솔(16.54％비29.55％,P＜0.05)화현저증고적림상임신솔(43.78％비34.38％,P＜0.05)、활산솔(34.16％비23.44％.P＜0.05).결론 구복지굴잉동황체지지재자연주기FET존재우세,우기재단순수란관인소불잉환자.
Objective To determine whether luteal support of dydrogesterone may enhance the outcome of frozen-thawed embryo transfer (FET) in natural cycles by comparing the FET outcomes of different luteal support methods.Methods A total of 2 248 natural FET cycles with an endometrial thickness of 8-12 mm and type A on ovulation day,from January 2011 to March 2013 were chosen.Oral dydrogesterone (n =1 967) or intramuscular progesterone (n =281) was used for luteal support.The rates of clinical pregnancy,implantation,ectopic pregnancy,miscarriage and live birth were compared among these groups.Results The patients receiving oral dydrogesterone or intramuscular progesterone had similar profiles of age,type of infertility,endometrial thickness and average numbers of embryo transfer.The dydrogesterone group had higher rates of clinical pregnancy (43.26％ vs 38.79％) and implantation (25.76％ vs 21.13％).However a lower miscarriage rate (17.27％ vs 22.02％) was insignificant.The rates of ectopic pregnancy,premature birth and live birth were also similar.When infertile factors were considered,the dydrogesterone group had significantly higher clinical pregnancy rates (43.78％ vs 34.38％,P＜0.05),lowered miscarriage rates (16.54％ vs 29.55％,P ＜ 0.05) and increased live birth rates (34.16％ vs 23.44％,P ＜ 0.05) among simple tubal factor patients.Conclusion Oral administration of dydrogesterone for luteal support offers more advantages in natural cycle FET than intramuscular progesterone,especially for simple tubal factor infertility.