不同黄体酮给药方案对行胚胎植入前遗传学检测的冻融胚胎移植患者的影响及治疗成本分析

［摘要］　目的　分析不同黄体酮给药方案对行胚胎植入前遗传学检测的冻融胚胎移植（PGT-FET）患者的影响及治疗成本。方法　回顾性分析2020年8月至2022年7月在十堰市太和医院生殖医学中心进行PGT-FET的169例不孕患者的临床资料，根据患者采用的黄体酮给药方案将其分为A组（黄体酮胶囊口服，82例）和B组（黄体酮软胶囊阴道上药，87例）。比较两组注射人绒毛膜促性腺激素（HCG）日激素指标及获卵情况、注射HCG日和移植日子宫内膜厚度及容受性指标［阻力指数（RI）、搏动指数（PI）和收缩期峰值流速/舒张末期流速（S/D）］、囊胚移植、妊娠结局、阴道出血情况及成本-效果比。结果　两组注射HCG日促黄体生成素（LH）、注射HCG日雌二醇（E₂）、注射HCG日孕酮（P）、获卵数、MⅡ卵子数，注射HCG日和移植日子宫内膜厚度及子宫动脉S/D、RI、PI，移植囊胚数、移植优质囊胚率、生化妊娠率、临床妊娠率、早期流产率及继续妊娠率比较差异无统计学意义（P>0.05）。A组阴道早期出血率和晚期出血率显著低于B组（P<0.05）。A组成本-效果比为6.72，低于B组的8.41。结论　PGT-FET患者采用黄体酮胶囊口服治疗与黄体酮软胶囊阴道上药治疗所获临床效果及对子宫内膜容受性的保护作用较为接近，但前者可以降低阴道出血率和治疗成本。

Analysis on the effects and treatment costs of different progesterone administration regimens on patients undergoing preimplantation genetic testing for frozen-thawed embryo transfer

［Abstract］　Objective　To analyze the effects and treatment costs of different progesterone administration regimens on patients undergoing preimplantation genetic testing for frozen-thawed embryo transfer(PGT-FET). Methods　The clinical data of 169 infertile patients who underwent PGT-FET in the Reproductive Medicine Center of Taihe Hospital, Shiyan City from August 2020 to July 2022 were retrospectively analyzed. According to the progesterone administration regimens adopted by the patients, the patients were divided into group A(oral administration of progesterone capsules, 82 cases) and group B(vaginal administration of progesterone softgel capsules, 87 cases). The hormonal indicators and oocyte harvest on the day of injection of human chorionic gonadotropin(HCG), endometrial thickness and receptivity indicators［resistance index(RI), pulse index(PI) and peak systolic velocity/end diastolic velocity(S/D)］ on the day of injection of HCG and on the day of embryo transfer, embryo transfer, pregnancy outcomes, vaginal bleeding and cost-effectiveness ratio were compared between the two groups. Results　There were no significant differences between the two groups in luteinizing hormone(LH) on the day of injection of HCG, estradiol(E₂) on the day of injection of HCG, progesterone(P) on the day of injection of HCG, number of oocyte harvest, number of MⅡoocytes, and endometrial thickness and uterine artery S/D, RI, PI on the day of injection of HCG and on the day of embryo transfer, the number of transferred blastocysts, the rate of high-quality transferred blastocysts, biochemical pregnancy rate, clinical pregnancy rate, first trimester abortion rate and continue pregnancy rate(P>0.05). The rate of early vaginal bleeding and the rate of late vaginal bleeding in the group A were significantly lower than those in the group B(P<0.05). The cost-effectiveness ratio of the group A(6.72) was lower than that of the group B(8.41). Conclusion　In PGT-FET patients, the clinical effect of oral administration of progesterone capsules and the protective effect of oral administration of progesterone capsules on endometrial receptivity are similar to those of vaginal administration of progesterone softgel capsules, but the former treatment can reduce the rate of vaginal bleeding and treatment costs.