地屈孕酮与人类绝经促性腺激素方案在体外受精/卵胞浆内单精子注射治疗中联合胚胎冷冻保存时对正常排卵妇女控制性卵巢超排卵。
Duphaston and human menopausal gonadotropin protocol in normally ovulatory women undergoing controlled ovarian hyperstimulation during in vitro fertilization/intracytoplasmic sperm injection treatments in combination with embryo cryopreservation.
机构信息
Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
出版信息
Fertil Steril. 2017 Sep;108(3):505-512.e2. doi: 10.1016/j.fertnstert.2017.06.017. Epub 2017 Jul 8.
OBJECTIVE
To evaluate endocrine characteristics and clinical outcomes in normal ovulatory patients undergoing controlled ovarian hyperstimulation (COH) with the use of a Duphaston and hMG protocol during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments in combination with frozen-thawed embryo transfer (FET) compared with the characteristics and outcomes of patients undergoing an Utrogestan and hMG protocol.
DESIGN
Prospective controlled study.
SETTING
Tertiary care academic medical center.
PATIENT(S): A total of 250 infertile patients undergoing IVF/ICSI treatments.
INTERVENTION(S): Duphaston (20 mg/d) or Utrogestan (100 mg/d) was taken orally from cycle day 3 until the trigger day, with hMG (150-225 IU) administered when appropriate. When the dominant follicles reached maturity, 0.1 mg GnRH agonist was used as the trigger. Viable embryos were cryopreserved in both protocols for transfer at a later time.
MAIN OUTCOME MEASURE(S): The primary outcome was the number of oocytes retrieved. Secondary outcomes included the incidence of premature LH surge, the number of viable embryos, and clinical pregnancy outcomes from FET cycles.
RESULT(S): Consistent LH suppression was achieved during COH. None of the participants experienced a premature LH surge. The number of oocytes retrieved (8.22 ± 5.46 vs. 8.8 ± 5.62) was similar between the two groups. No between-group significant differences were observed in the number of mature oocytes (7.2 ± 4.72 vs. 6.98 ± 4.68), fertilized oocytes (6.16 ± 4.34 vs. 6.32 ± 4.23), and viable embryos (2.96 ± 2.22 vs. 3.4 ± 2.54). Furthermore, the clinical pregnancy rates (53.04% vs. 51.7%), early miscarriage rates (8.2% vs. 11.84%), implantation rates (38.68% vs. 35.71%), and cumulative pregnancy rates per woman (66.67% vs. 69.47%) were also similar.
CONCLUSION(S): Duphaston administration during COH was similar to Utrogestan in the prevention of LH surge, embryonic characteristics, and pregnancy outcomes.
CLINICAL TRIAL REGISTRATION NUMBER
ChiCTR-IOR-15007265.
目的
评估在体外受精（IVF）/胞浆内精子注射（ICSI）治疗中使用地屈孕酮和 hMG 方案与使用黄体酮和 hMG 方案进行控制性卵巢过度刺激（COH）的正常排卵患者的内分泌特征和临床结局，并比较冷冻胚胎移植（FET）后的情况。
设计
前瞻性对照研究。
地点
三级保健学术医疗中心。
患者
共 250 名接受 IVF/ICSI 治疗的不孕患者。
干预
地屈孕酮（20mg/d）或黄体酮（100mg/d）从周期第 3 天开始口服至扳机日，当需要时给予 hMG（150-225IU）。当主导卵泡成熟时，使用 0.1mg GnRH 激动剂作为扳机。在两种方案中均将有活力的胚胎冷冻保存，以便以后进行移植。
主要观察指标
主要结局是获得的卵母细胞数量。次要结局包括 LH 过早激增的发生率、有活力的胚胎数量以及 FET 周期的临床妊娠结局。
结果
COH 期间实现了一致的 LH 抑制。没有参与者出现 LH 过早激增。两组获得的卵母细胞数量（8.22±5.46 与 8.8±5.62）相似。两组间成熟卵母细胞数量（7.2±4.72 与 6.98±4.68）、受精卵母细胞数量（6.16±4.34 与 6.32±4.23）和有活力的胚胎数量（2.96±2.22 与 3.4±2.54）无显著差异。此外，临床妊娠率（53.04% 与 51.7%）、早期流产率（8.2% 与 11.84%）、种植率（38.68% 与 35.71%）和每个女性的累积妊娠率（66.67% 与 69.47%）也相似。
结论
在预防 LH 激增、胚胎特征和妊娠结局方面，地屈孕酮在 COH 中的应用与黄体酮相似。
临床试验注册号
ChiCTR-IOR-15007265。
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