口服地屈孕酮在激素替代周期冻融胚胎移植中的应用效果#br#

目的　探讨单纯口服地屈孕酮在冻融胚胎移植（FET）激素替代周期中内膜转化及黄体支持的有效性。方法　选择35周岁以下因各种原因全胚冷冻后首次行FET的患者200例，采用随机数字表法分为对照组和观察组，各100例。入选患者均采用激素替代周期进行内膜准备，当内膜厚度≥8 mm，血清雌二醇（E2）≥549 pmol/L时进行内膜转化。观察组单纯口服地屈孕酮20 mg/次，2次/d；对照组口服地屈孕酮（10 mg/次，2次/d）+放置黄体酮阴道缓释凝胶90 mg/d。在2组患者转化内膜3 d后行卵裂期胚胎移植，5 d后行囊胚移植。移植当日至移植后14 d，观察组继续单纯口服地屈孕酮片40 mg/d，对照组继续口服地屈孕酮20 mg/d+阴道放置黄体酮阴道缓释凝胶90 mg/d进行黄体支持，若患者妊娠则黄体支持维持至移植后60 d。比较2组患者的种植率、临床妊娠率、早期妊娠流产率、用药满意度、药物不良反应及药物费用。结果　对照组、观察组患者种植率分别为50.98%（78/153）、49.34%（75/152），临床妊娠率分别为67.00%（67/100）、65.00%（65/100），早期妊娠流产率分别为8.96%（6/67）、9.23%（6/65），2组间差异均无统计学意义。观察组用药满意度明显高于对照组，药物费用显著低于对照组（P＜0.05），药物不良反应发生率与对照组差异无统计学意义。结论　在激素替代周期FET中，单纯口服地屈孕酮进行内膜转化及黄体支持安全有效，值得临床推广应用。

The effect of oral dydrogesterone on frozen-thawed embryo transfer in hormone replacement cycle#br#

Objective　 To investigate the effect of oral dydrogesterone alone on endometrial transformation and luteal support in hormone replacement cycles of frozen thawed embryo transfer (FET). Methods　 Two hundred patients under the age of 35 years who underwent FET for the first time after whole embryo freezing for various reasons were randomly selected and divided into control group and observation group with 100 cases for each group. All enrolled patients underwent endometrial preparation with hormone replacement cycles, and endometrial transformation was performed when the endometrial thickness was ≥ 8 mm and serum estradiol (E2) ≥ 549 pmol/L. The observation group received dydrogesterone 20 mg/time, twice/d orally only. The control group received dydrogesterone (10 mg/time, twice/d) orally + vaginal plug by placing progesterone vaginal sustained-release gel 90 mg/d. The cleavage stage embryo transfer was performed 3 d after the conversion of endo-metrium and 5 d after the blastocyst transfer in the 2 groups of patients. From the day of transplantation until 14 days after transplantation, the observation group continued to take oral dydrogesterone tablets 40 mg/d alone, and the control group continued with oral dydrogesterone 20 mg/d + vaginal plugs placed with progesterone vaginal sustained release gel 90 mg/d for luteal support. If the patient was pregnant, luteal support was maintained until 60 days after transplantation. The implantation rate, clinical pregnancy rate, early pregnancy loss rate, satisfaction with medication, adverse drug reactions and cost of medication were compared between the 2 groups. Results　 The implantation rates of patients in control and observation groups were 50.98% (78/153) and 49.34% (75/152), clinical pregnancy rates were 67.00% (67/100) and 65.00% (65/100), and early pregnancy abortion rates were 8.96% (6/67) and 9.23% (6/65), respectively, with no significant differences between the 2 groups. The medication satisfaction was significantly higher in observation group than that of thecontrol group, and the medication cost was significantly lower in observation group than that of the control group (P < 0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups. Conclusion　 In FET with hormone replacement cycle, endometrial transformation and luteal support with oral dydrogesterone alone are safe and effective, which is worthy of clinical promotion and application.