Khrouf Mohamed, Slimani Soufiene, Khrouf Myriam Razgallah, Braham Marouen, Bouyahia Maha, Berjeb Khadija Kacem, Chaabane Hanene Elloumi, Merdassi Ghaya, Kaffel Aida Zahaf, Zhioua Amel, Zhioua Fethi
Professor Associate, ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
MD, ART Center Aziza Othmana Hospital, Faculté de Médecine de Tunis, Université Tunis Manar, Tunisia.
Clin Med Insights Womens Health. 2017 Jan 5;9:43-47. doi: 10.4137/CMWH.S32156. eCollection 2016.
In IVF, Luteal phase support is usually performed using vaginal progesterone. A part of patients using this route reports being uncomfortable with this route. We tried to study whether the rectal route could be an effective alternative and associated with less discomfort.
A prospective randomized controlled study. All patient were eligible for IVF treatment for infertility. After oocyte pickup, 186 patients were allocated to one the following protocols for luteal phase support: (i) rectal pessaries group: natural progesterone pessaries administered rectally 200 mg three times a day, (ii) vaginal pessaries group: natural progesterone pessaries administered vaginally 200 mg three times a day), and (iii) vaginal capsules group: natural micronized progesterone capsules administered vaginally 200 mg three times a day. On the day of pregnancy test, patients were asked to fill in a questionnaire conducted by an investigator in order to assess the tolerability and side effects of the LPS treatment taken. The primary endpoint was the occurrence of perineal irritation.
Fifty eight patients were assigned to the rectal pessaries group, 68 patients to the vaginal pessaries group, and 60 patients to the vaginal capsules group. All patients adhered to their allocated treatment. Implantation and clinical pregnancy rates per transfer did not differ between the three groups. Perineal irritation, which was our primary endpoint, was the same for all the three groups (respectively 1.7 % versus 5.9 % versus 11.7%). Regarding the other side effects, more patients experienced constipation and flatulence with the rectal route, whereas more patients reported vaginal discharge in the vaginal capsules group.
Rectal administration for luteal phase support is effective and well accepted alternative to vaginal route.
在体外受精（IVF）中，黄体期支持通常采用阴道用黄体酮。部分采用此途径的患者表示对此途径感到不适。我们试图研究直肠途径是否可能是一种有效的替代方法且不适感较小。
一项前瞻性随机对照研究。所有患者均符合因不孕症接受IVF治疗的条件。取卵后，186例患者被分配至以下黄体期支持方案之一：（i）直肠栓剂组：每天经直肠给予天然黄体酮栓剂200mg，每日3次；（ii）阴道栓剂组：每天经阴道给予天然黄体酮栓剂200mg，每日3次；（iii）阴道胶囊组：每天经阴道给予天然微粒化黄体酮胶囊200mg，每日3次。在妊娠试验当天，要求患者填写由研究者进行的问卷，以评估所采用的黄体期支持治疗的耐受性和副作用。主要终点是会阴刺激的发生情况。
58例患者被分配至直肠栓剂组，68例患者被分配至阴道栓剂组，60例患者被分配至阴道胶囊组。所有患者均坚持其分配的治疗方案。三组之间每次移植的着床率和临床妊娠率无差异。作为我们主要终点的会阴刺激在三组中相同（分别为1.7%对5.9%对11.7%）。关于其他副作用，直肠途径组更多患者出现便秘和肠胃胀气，而阴道胶囊组更多患者报告有阴道分泌物。
直肠给药用于黄体期支持是一种有效的替代阴道途径且易于接受的方法。
