生殖医学杂志

目的比较冻融囊胚移植周期中采用不同黄体酮制剂联合用药进行黄体支持的妊娠结局及药物费用。方法采用前瞻性随机研究,2012年10月至2013年4月在温州医科大学附属第一医院生殖中心行冻融囊胚激素替代周期的患者160例,均采用芬吗通白片先口服后阴道给药方式准备子宫内膜。按照不同的黄体支持方法随机分为3组:A组64例,采用黄体酮针剂注射(60mg每日1次)联合地屈孕酮片口服(10mg每日2次);B组50例,采用黄体酮阴道缓释凝胶阴道给药(90mg每日1次)联合地屈孕酮片口服(10mg每日2次);C组46例,采用黄体酮针剂注射(60mg每日1次)联合微粒化黄体酮软胶囊阴道给药(200mg每日2次)。两两比较A、B组及A、C组患者的妊娠结局、黄体酮药物费用。结果分别两两比较A、B组及A、C组的内膜厚度、内膜类型、开始使用孕激素日雌二醇及孕酮水平、平均移植胚胎数、种植率、生化妊娠率、临床妊娠率、多胎妊娠率、早期流产率及异位妊娠率,差异均无统计学意义(P>0.05)。B组每移植周期黄体酮药物费用1538.5元、每获得1例临床妊娠所需费用3 077元,均高于A组的261.29元、522.58元和C组的271.49元、624.73元。接受黄体酮注射患者局部红肿发生率2.7%。接受阴道缓释凝胶及微粒化软胶囊阴道给药患者出现阴道分泌物增多、伴瘙痒的发生率分别为2.0%及10.9%,差异无统计学意义(P>0.05)。接受地屈孕酮口服的患者发生轻度胃肠道不适为1.76%。结论对于冻融囊胚移植周期,联合多途径不同黄体支持方法均可获得比较满意的临床结果。相比较于给药更简便,患者舒适度高但价格较贵的黄体酮缓释凝胶联合地屈孕酮片组(B组),黄体酮针剂联合地屈孕酮片(A组)或微粒化黄体酮软胶囊组更经济(C组)。根据患者具体的经济情况、给药方式的接受度、对不适反应的认识程度来制定不同的黄体支持方案。

Objective:To compare the outcomes and drug costs of the different protocols for luteal phase support in frozen-thawed blastocyst transfer cycle.Methods:A total of 160 infertile women received hormonal replacement treatment in frozen-thawed blastocyst transfer cycle were recruited for this prospective randomized study in Reproductive Medicine Center,the First Affiliated Hospital of Wenzhou Medical University from Oct.2012 to Apr.2013.The patients who were taken estradiol tablets for preparing the endomitrium firstly were randomly divided to three groups:64patients received intramuscular injection of progesterone(IMP)60mg/day and 10 mg oral dydrogesterone twice per day in group A;50patients received Crinone 8% vaginal gel(90mg)daily and oral dydrogesterone 10 mg twice per day in Group B;46patients used IMP 60mg/day and Utrogestan vaginal capsules 200 mg twice daily in Group C.The blastocysts were thawed and transferred 5days later.Finally,the clinical outcomes and the drug costs were evaluated among the three groups.Results:There was no significant difference in the endometrial thickness,the levels of estradiol and progesterone on the day of progesterone administration,the average number of embryo transferred,implantation rate,biochemical pregnancy rate,clinical pregnancy rate,early abortion rate,multiple pregnancy rate,ectopic pregnancy rate between Group A & Group B or Group A & C(P>0.05).The cost of progesterone was $261.29,$1 538.5and $271.49 per cycle in Group A,Group B and Group C respectively.The cost for one successful pregnancy was $3 077 in Group B,which was the highest compared with Group A($522.58)and Group C($624.73).Abort 2.7% of the patients with IMP complained redness and swelling at the injection site.In addition,2.0%of the patients with vaginal gel and10.9% of the patients with Utrogestan vaginal capsules appeared pruritus and irritation,but there was no significant difference(P>0.05).Furthermore,1.76% of the patients with oral dydrogesterone felt mild gastrointestinal discomfortable.Conclusions:All the protocols of administration of different progesterone for luteal phase support are effective in frozen-thawed blastocyst transfer cycle.Progesterone vaginal gel combined with oral dydrogesterone is convenient,comfortable but expensive.Intramuscular injection of progesterone combined with oral dydrogesterone or Utrogestan capsules is economic.Administration of different protocols for luteal phase support should depend on the patient's economic conditions,acceptance to the administration methods and adaptability to the adverse reaction.