Dilday Elizabeth, Gigg Marisa, Hoyos Luis, Quinn Molly, Markovic Daniela, Kroener Lindsay
UCLA Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, David Geffen School of Medicine, Los Angeles CA, USA.
UCLA Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, David Geffen School of Medicine, Los Angeles CA, USA.
Reprod Biomed Online. 2023 Jan;46(1):123-128. doi: 10.1016/j.rbmo.2022.09.012. Epub 2022 Sep 20.
Does luteal phase support with vaginal progesterone improve clinical pregnancy rates in patients undergoing ovarian stimulation with letrozole?
This was a retrospective cohort study of patients undergoing ovarian stimulation with letrozole paired with intrauterine insemination (IUI) or timed intercourse (TIC) from January 2018 to October 2021. The primary outcome of clinical pregnancy rate (CPR) was calculated for cycles with and without luteal phase progesterone support. Univariate logistic regressions were done to evaluate predictor variables for CPR. Clinically important covariates including age, body mass index, anti-Müllerian hormone concentration, diagnosis of ovulatory dysfunction and multifollicular development were included in a multivariate analysis evaluating the relationship between luteal progesterone use and odds of clinical pregnancy. Secondary outcomes including spontaneous abortion, biochemical pregnancy and ectopic pregnancy were calculated. Live birth rates were calculated for cycles in a secondary analysis.
A total of 492 letrozole ovarian stimulation cycles in 273 patients were included. Of these cycles, 387 (78.7%) used vaginal progesterone for luteal support and 105 (21.3%) did not. The unadjusted CPR per cycle was 11.6% (45/387) with progesterone and 13.3% (14/105) without progesterone (P = 0.645). After adjusting for significant covariates including age, BMI, diagnosis of ovulatory dysfunction and multifollicular development, the odds for clinical pregnancy were not significantly improved in cycles with exogenous progesterone (odds ratio [OR] 1.15, 95% confidence interval [CI] 0.48-2.75, P = 0.762). A follow-up analysis demonstrated that live birth rate was 10.7% (41/384) with and 12.5% (13/104) without luteal progesterone, respectively (P = 0.599).
Luteal support with vaginal progesterone does not significantly improve CPR in ovarian stimulation cycles using letrozole.
对于接受来曲唑促排卵的患者，阴道用黄体酮进行黄体期支持能否提高临床妊娠率？
这是一项回顾性队列研究，研究对象为2018年1月至2021年10月期间接受来曲唑促排卵并联合宫腔内人工授精（IUI）或定时性交（TIC）的患者。计算有或无黄体期黄体酮支持周期的临床妊娠率（CPR）这一主要结局。进行单因素逻辑回归以评估CPR的预测变量。在多因素分析中纳入了包括年龄、体重指数、抗苗勒管激素浓度、排卵功能障碍诊断和多卵泡发育等临床重要协变量，以评估黄体期使用黄体酮与临床妊娠几率之间的关系。计算包括自然流产、生化妊娠和异位妊娠在内的次要结局。在一项次要分析中计算各周期的活产率。
共纳入273例患者的492个来曲唑促排卵周期。在这些周期中，387个（78.7%）使用阴道黄体酮进行黄体支持，105个（21.3%）未使用。使用黄体酮时每个周期未经调整的CPR为11.6%（45/387），未使用黄体酮时为13.3%（14/105）（P = 0.645）。在调整了包括年龄、体重指数、排卵功能障碍诊断和多卵泡发育等显著协变量后，使用外源性黄体酮的周期临床妊娠几率未显著提高（优势比[OR] 1.15，95%置信区间[CI] 0.48 - 2.75，P = 0.762）。一项随访分析表明，有和无黄体期黄体酮时的活产率分别为10.
