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目的探讨不同黄体支持方法与人工授精的妊娠结局及妊娠周期雌二醇(E2)、孕酮(P)、E2/P动态变化规律,黄体支持中合理的E2/P比值,确定合理的黄体支持方法。方法对接受供精人工授精促排卵助孕治疗的患者172个治疗周期随机分成3组,分别在排卵后第3天开始接受人绒毛膜促性腺激素(hCG)注射(A组),hCG+黄体酮注射(B组)和口服黄体酮胶囊(C组)三种不同黄体支持方法,比较三者的妊娠结局,连续检测妊娠周期早卵泡期、排卵期(hCG日)、孕卵着床期(窗口期),以及早孕期、孕6、7～8周体内E2、P水平。结果三种不同黄体支持方法中B组妊娠成功率高于其他两组;排卵用药后各个时期P水平C组最高,A、B两组之间无差异;B组与正常妊娠组E2/P比值及变化趋势最相近。结论 hCG+黄体酮注射组虽无口服黄体酮胶囊组提高P浓度作用显著,但周期妊娠率最高,而且与妊娠对照组E2/P比值及变化趋势最接近,因此在黄体支持不仅要提高P浓度,尚需维持合适的雌孕激素的比值,提示hCG+黄体酮注射是三种方案中的最佳支持方法。
Abstract：Objective:To explore the preferable luteal phase support method in artificial insemination therapy. Methods:A total of 172 artificial insemination cycles in our reproductive center were randomly assigned to receive one of 3 different luteal phase support methods 3 days after ovulation;human chorionic gonadotropin(hCG) injection(group A),hCG + progesterone(P) injection(group B) or progesterone capsule(group C).Serum levels of estradiol(E2) and P were consecutively measured in early follicular phase(day 2 of menstrual cycle),ovulation phase(day of hCG administration),and 3,6,9 and 16 days after ovulation,and if pregnant,in early pregnancy,middle pregnancy and late pregnancy as well.The pregnancy rate were compared among three groups. Results:The pregnancy rate in group B(hCG + P injection) was higher than that in group A(hCG injection, P<0.05).There was no significant difference in pregnancy rate between group A and C or between group B and C.Serum levels of progesterone in group C at 6,9 and 16 days after ovulation were significantly higher than those in group A or group B.There was no significant difference in serum progesterone levels at each time point between group A and group B.The E2/P ratios in group B were most similar to those of normal pregnant women. Conclusions:The pregnancy rate in group B(hCG + P injection) was the highest among 3 groups and the E2/P ratios in group B most resembled those in normal pregnant women.An ideal luteal phase support should not only increase the progesterone levels but also maintain a rational E2/P ratio.
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基本信息:
中图分类号:R714.8
引用信息:
[1]耿琳琳,曹炀,黄俊.人工授精手术中不同黄体支持方法作用的研究[J].生殖医学杂志,2011,20(01):9-13.
基金信息:
中央级公益性科研院所基本科研业务费专项(2007GJSSJKB03)
2011-02-15
2011-02-15