不同剂量黄体酮在体外受精-胚胎移植中黄体支持的效果

目的:探讨不同剂量黄体支持对IVF-ET周期黄体期雌、孕激素水平及临床结局的影响。方法:回顾分析长方案超促排卵IVF-ET305周期,根据hCG日雌激素水平采取4种不同黄体支持方案;对照组53例,hCG日血清E2值≤8000pmol/L,胚胎移植日开始肌注黄体酮60mg/d到验孕日。实验组:A组43例,hCG日血清E2值≤4000pmol/L,在取卵第2天开始肌注黄体酮20mg/d联合2000IU hCG q3d×4次到验孕日;B组115例,hCG日E24000pmol/L～8000pmol/L,取卵后第2天开始肌注40mg/d黄体酮到验孕日;C组94例,hCG日血清E2值≥8000pmol/L,取卵后第2天开始肌注60mg/d黄体酮到验孕日。结果:4组患者年龄、不孕年限、不孕因素、Gn用药天数、用药量、移植胚胎数均无明显差异(P0.05);4组hCG日雌激素水平、获卵数、ET日和种植窗期雌激素水平均有显著差异(P0.05),但4组ET日及种植窗期的E2/P值无显著差异;4组的种植率和妊娠率分别为27.68%、32.18%、32.54%、29.33%和41.51%、46.51%、50.43%、42.55%,无统计学差异。结论:不同剂量黄体支持有助于维持黄体期雌、孕激素平衡,有利于减少黄体酮剂量而不影响妊娠结局。

Effect of different doses of progesterone on luteal support in IVF-ET outcome

Objective:To study the effect of different doses of progesterone on luteal support in IVF-ET.Methods:A total of 305 long protocol superovulation and IVF-ET cycles were divided into 4 groups according to the serum estradiol(E2) levels on the day of hCG administration.Control group:53 cycles,which E2 levels ≤8000 pmol/L,received the progesterone 60mg/d as the luteal support.Trial group was devided into A、B、C group,Group A:43 cycles,which E2 levels≤4000pmol/L,received progesterone 20 mg/d combined with hCG 2000 IU/3d as the luteal support.Group B:115cycles,which E2 levels were between group A and group C,received the progesterone 40mg/d as the luteal support.Group C:94 cycles,which E2 levels ≥8000pmol/L,received the progesterone 60mg/d as the luteal support.Results:There were no difference on average age,infertility duration,cause of infertility,duration of stimulation,ampules of Gonal-F and number of embryos transferred in 4 groups.The levels of E2 on the day of hCG administration and number of oocytes retrieved,serum E2 and progesterone levels on ET day and the day+3 after ET were statistically significant(P<0.05).But there was no statistical difference on the ratio of E2/P on the day of ET and the day +3 after ET in 4 groups;the implantation and clinical pregnancy rates were respectively 27.68%、32.18%、32.5%、29.33%and 41.51%、46.51%、50.43%、42.55% in 4 groups,which were not statistically significant.Conclusions:According to E2 levels on hCG day,different dosage luteal support is necessary after IVF-ET and benefit to maintaining proportion of E2/P ratio,with a consequent improvement in implantation and clinical pregnancy rate.