Tay P Y, Lenton E A
Department of Obstetrics and Gynaecology, University of Malaya, 50603, Kuala Lumpur.
Med J Malaysia. 2003 Jun;58(2):187-95.
A prospective randomised study was done to assess the effect of supplemental oestradiol in addition to progesterone on the luteal steroid profiles and pregnancy outcome in stimulated cycles with and without pituitary down regulation. Women undergoing stimulated cycle IVF with GnRH-a and FSH (Group A, n = 63) or stimulated intrauterine insemination using CC and FSH (Group B, n = 55) were studied. These subjects were randomly allocated to receive either 400 mg daily of vaginally administrated Cyclogest (progesterone) alone or in combination with 2 mg daily of oral Oestradiol Valerate (E2V) during the luteal phase. Significant lower concentrations of plasma progesterone were observed in those subjects supplemented with both E2V and progesterone compared to those in whom progesterone only was given during the luteal phase (P < 0.05). Exogenous E2V had a minimal impact on plasma oestradiol concentrations and did not disguise the characterised mid luteal decline in oestradiol secretion. The suppressive effect of E2V on plasma progesterone was lost if implantation occurred normally because any small change in steroid concentrations was reversed by the rapidly increasing concentrations of HCG. Similar pregnancy rates were observed among subjects supplemented with or without oestradiol. The addition of oestradiol to the luteal supplement suppresses endogenous corpus luteum progesterone secretion irrespective of the type of assisted conception cycle and that its use is unlikely to be beneficial to the process of implantation.
进行了一项前瞻性随机研究，以评估在有或没有垂体降调节的刺激周期中，除孕酮外补充雌二醇对黄体类固醇谱和妊娠结局的影响。研究了接受促性腺激素释放激素激动剂（GnRH-a）和促卵泡素（FSH）进行刺激周期体外受精的女性（A组，n = 63）或使用克罗米芬（CC）和FSH进行刺激宫内人工授精的女性（B组，n = 55）。这些受试者在黄体期被随机分配接受每天400mg经阴道给药的黄体酮（Cyclogest），单独使用或与每天2mg口服戊酸雌二醇（E2V）联合使用。与仅在黄体期给予孕酮的受试者相比，补充E2V和孕酮的受试者血浆孕酮浓度显著降低（P < 0.05）。外源性E2V对血浆雌二醇浓度影响最小，并且没有掩盖黄体中期雌二醇分泌的特征性下降。如果正常发生着床，E2V对血浆孕酮的抑制作用就会消失，因为类固醇浓度的任何微小变化都会被快速升高的人绒毛膜促性腺激素（HCG）浓度逆转。补充或不补充雌二醇的受试者中观察到相似的妊娠率。在黄体期补充剂中添加雌二醇会抑制内源性黄体孕酮分泌，无论辅助受孕周期的类型如何，并且其使用不太可能对着床过程有益。
