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目的:比较口服地屈孕酮联合阴道用微粒化黄体酮黄体支持与肌肉注射黄体酮应用于冻融胚胎移植(FET)激素替代黄体支持的临床效果。方法:月经第3日起口服17β雌二醇片8 mg;第14日超声监测,同时测定血清E2,内膜≥8 mm、E2≥150 pg/ml时,加用口服地屈孕酮40 mg联合阴道用微粒化黄体酮软胶囊400 mg(A组)转化内膜,或肌注油剂黄体酮60 mg(B组),3～5 d后解冻第3～5日胚胎。结果:共完成1 805个FET激素替代周期,A、B组临床妊娠率分别为41.4%(389/940)、38.4%(332/865),种植率分别为26.2%(485/1 851)、23.8%(438/1 837),继续妊娠率分别为34.1%(321/940)、33.4%(289/865),组间均无统计学差异;A组流产率为19.8%(77/389),高于B组的13%(43/332)(P<0.05)。结论:FET激素替代周期中口服地屈孕酮与阴道塞安琪坦联合用药,简单方便,临床结果理想,可逐步替代肌肉注射油剂黄体酮。
OBJECTIVE: To compare the clinical efficacy of oral delivery of progesterone combined with vaginal micronized progesterone luteal support and intramuscular injection of progesterone in the replacement of luteal phase with freeze-thawed embryo transfer (FET) hormones. Methods: Oral 17beta estradiol tablets were administered orally on the third day after menstruation. On the 14th day, the serum E2 was measured, while the E2 level was ≥8 mm and the E2≥150 pg / ml. Oral dydrogesterone 40 mg The vagina was treated with 400 mg of microencapsulated progesterone soft capsule (group A) or 60 mg of progesterone (group B), and the 3rd to 5th embryos were thawed after 3 ~ 5 d. Results: A total of 1 805 FET replacement cycles were completed. The clinical pregnancy rates in group A and group B were 41.4% (389/940) and 38.4% (332/865), respectively. The implantation rates were 26.2% (485/1 851) 23.8% (438/1 837) and 34.1% (321/940) and 33.4% (289/865) respectively. There was no significant difference between the two groups. The abortion rate in group A was 19.8% (77/389) , Higher than 13% (43/332) in group B (P <0.05). Conclusion: The combination of oral administration of progesterone and vaginal plug-ganache in the hormone replacement period of FET is simple and convenient, and the clinical result is ideal. It can gradually substitute the intramuscular injection of progesterone.