生殖医学杂志

目的探讨两种孕激素在卵泡期高孕激素状态下促排卵(PPOS)方案中的治疗效果。方法回顾分析2017年1月至2020年1月就诊于贵州医科大学附属医院生殖中心行PPOS方案促排卵的468周期的临床资料,根据使用孕激素种类的不同分为地屈孕酮组(n=174)和醋酸甲羟孕酮(MPA)组(n=294),比较两组患者的促排卵结局及冻融胚胎移植(FET)临床结局。结果两组患者的年龄、体质量指数(BMI)、不孕年限、基础LH水平、卵巢储备功能减退(DOR)率、Gn天数、窦卵泡数等一般情况比较均无显著差异(P>0.05);地屈孕酮组基础FSH水平显著高于MPA组[(11.41±6.32) vs.(10.01±4.89)U/L,P<0.05]。两组患者间获卵数、周期获卵率、重复取卵率、正常受精率、优胚率、移植周期占比、冷冻周期率比较均无显著差异(P>0.05),两组患者均未出现早发LH峰及中/重度OHSS;地屈孕酮组Gn用量显著小于MPA组[(2 846.12±1 043.64) vs.(3 045.66±999.13)U,P<0.05];两组患者间剩余胚胎率、胚胎种植率、临床妊娠率、生化妊娠率、流产率、早产率、活产率比较均无显著差异(P>0.05)。结论在PPOS方案中,地屈孕酮与MPA的促排卵结局和FET临床结局相当,但地屈孕酮组Gn用量少,安全经济。

Objective:To explore the difference in the therapeutic effect of two progestins with progestin primed ovarian stimulation(PPOS) protocol in follicular phase.Methods:The clinical data of 468 cycles with PPOS protocol in the Reproductive Center of The Affiliated Hospital of Guizhou Medical University from January 2017 to January 2020 were retrospectively analyzed. According to the different types of progestin used, the cycles were divided into two groups: dydrogesterone group(n=174) and medroxyprogesterone acetate group(n=294). The outcome of ovarian induction and frozen-thawed embryo transfer(FET) were compared between the two groups.Results:There were no significant differences in the general conditions, such as, age, BMI,infertility duration, basic LH,decreased ovarian reserve(DOR) rate, Gn days, and number of antral follicles between the two groups(P>0.05). The FSH levels in the dydrogesterone group were significantly higher than those in the medroxyprogesterone acetate group[(11.41±6.32) vs.(10.01±4.89) U/L,P<0.05]. There were no significant differences in the number of oocytes retrieved, oocyte retrieved per cycle, repeated oocyte retrieval rate, normal fertilization rate, good-quality embryo rate, percentage of transplantation cycle, and freezing cycle rate between the two groups(P>0.05). There was no early LH peak and moderate/severe OHSS in both groups. The doses of Gn used was significantly lower in the dydrogesterone group than those in the medroxyprogesterone acetate group[(2 846.12±1 043.64) vs.(3 045.66±999.13) U,P<0.05]. There were no significantly difference in the remaining embryo rate, embryo implantation rate, clinical pregnancy rate, biochemical pregnancy rate, miscarriage rate, premature birth rate and live birth rate between the two groups(P>0.05).Conclusions:In the PPOS protocol, the ovarian induction outcome and the clinical outcome are similar between the dydrogesterone group and the medroxyprogesterone acetate group. However, the doses of Gn used in dydrogesterone group are less, which was safer and more economical.