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审视证据:新鲜胚胎移植和冷冻胚胎移植期间补充孕酮

Examining the evidence: progesterone supplementation during fresh and frozen embryo transfer.

作者信息

Shapiro Daniel, Boostanfar Robert, Silverberg Kaylen, Yanushpolsky Elena Hesina

机构信息

Médical Director, Reproductive Biology Associates, Atlanta, GA, USA.

Director of Clinical Research, HRC Fertility, Los Angeles, CA, USA.

出版信息

Reprod Biomed Online. 2014 Dec;29 Suppl 1:S1-14; quiz S15-6. doi: 10.1016/S1472-6483(14)50063-6.

Abstract

ART has evolved over time and frozen-thawed embryo transfer (FET) is now a frequently performed, successful option. During the last decade, cryopreservation techniques have received considerable interest, whereas interest in the priming and preparation of the endometrium prior to and after embryo transfer was more limited. The available evidence for the rationale and timing of progesterone supplementation as well as an understanding of the differences among progesterone formulations with respect to efficacy, optimum use, and patient preference is worth examining. A Summit was convened to review the literature on progesterone supplementation in ART and after FET and to provide guidance on the most clinically relevant issues. Utilizing an innovative consensus-building model to examine the evidence, Summit faculty drafted summit statements prior to the meeting, completed a literature search, and created a presentation based on this. At the conclusion of their discussion the faculty developed final summit statements, evaluating the strength of the evidence supporting each statement, and rating their level of support for each statement. The clinically relevant topic areas were the rationale for progesterone supplementation, timing and appropriate dosing, whether progesterone sérum levels reflect outcomes, and distinguishing among progesterone formulations with respect to efficacy, tolerability, and patient preference/satisfaction.

摘要

辅助生殖技术(ART)随着时间不断发展,冻融胚胎移植(FET)如今已成为一种常用且成功的选择。在过去十年中,冷冻保存技术备受关注,而胚胎移植前后子宫内膜的预处理和准备方面的研究则相对较少。关于补充孕激素的原理和时机的现有证据,以及对不同孕激素制剂在疗效、最佳使用方法和患者偏好方面差异的理解,都值得探讨。为此召开了一次峰会,以回顾辅助生殖技术及冻融胚胎移植后补充孕激素的相关文献,并就最具临床相关性的问题提供指导。峰会专家利用创新的共识建立模型来审视证据,在会议前起草峰会声明,完成文献检索,并据此制作了一份报告。在讨论结束时,专家们制定了最终的峰会声明,评估支持每项声明的证据强度,并对每项声明的支持程度进行评级。具有临床相关性的主题领域包括补充孕激素的原理、时机和适当剂量、孕激素血清水平是否反映治疗结果,以及不同孕激素制剂在疗效、耐受性和患者偏好/满意度方面的差异。

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