Mochtar M H, Hogerzeil H V, Mol B W
Department of Obstetrics and Gynaecology, University of Amsterdam, The Netherlands.
Hum Reprod. 1996 Aug;11(8):1602-5. doi: 10.1093/oxfordjournals.humrep.a019453.
Two different regimens of luteal support in gonadotrophin hormone-releasing hormone (GnRH) analogue/human menopausal gonadotrophin (GnRHa/HMG)-induced in-vitro fertilization cycle (IVF) were compared in a randomized clinical trial. After embryo transfer, either vaginal progesterone alone was administered (n = 89, P group), or a combination of vaginal progesterone and human chorionic gonadotrophin (n = 87, P/HCG group). The primary aim of this study was to assess the effect of the different regimens of luteal support on the pregnancy rate. The secondary aim was to compare oestradiol and progesterone concentrations in the luteal phase between the two groups, and assess their effect on the pregnancy rate. A clinical pregnancy rate of 15% was found in the P/HCG group in comparison with 26% in the P group (odds ratio 0.49; 99% confidence interval: 0.18-1.3). The luteal serum oestradiol and progesterone values in the P/HCG group were significantly higher when compared with the P group on the 6th, 9th and 12th day after oocyte retrieval (Wilcoxon P < 0.001). In accordance with the high oestradiol concentrations, more cases of ovarian hyperstimulation syndrome (OHSS) were found in the P/HCG group. Oestradiol values on the 9th day after oocyte retrieval, presumably the day of implantation, appeared to be higher in women who did not become clinically pregnant. We conclude that vaginal progesterone alone provides sufficient luteal support in GnRHa/HMG induced IVF cycles. The combination of vaginal progesterone and HCG as luteal support leads to significant high luteal oestradiol and progesterone concentrations. But a high concentration of oestradiol seems to have a deleterious effect on the implantation process, resulting in a low pregnancy rate.
在一项随机临床试验中，比较了促性腺激素释放激素（GnRH）类似物/人绝经期促性腺激素（GnRHa/HMG）诱导的体外受精周期（IVF）中两种不同的黄体支持方案。胚胎移植后，要么单独给予阴道孕酮（n = 89，P组），要么给予阴道孕酮与人绒毛膜促性腺激素的组合（n = 87，P/HCG组）。本研究的主要目的是评估不同黄体支持方案对妊娠率的影响。次要目的是比较两组黄体期的雌二醇和孕酮浓度，并评估它们对妊娠率的影响。P/HCG组的临床妊娠率为15%，而P组为26%（优势比0.49；99%置信区间：0.18 - 1.3）。与P组相比，P/HCG组在取卵后第6、9和12天的黄体期血清雌二醇和孕酮值显著更高（Wilcoxon检验P < 0.001）。与高雌二醇浓度一致，P/HCG组发现更多卵巢过度刺激综合征（OHSS）病例。在未临床妊娠的女性中，取卵后第9天（大概是着床日）的雌二醇值似乎更高。我们得出结论，在GnRHa/HMG诱导的IVF周期中，单独使用阴道孕酮可提供足够的黄体支持。阴道孕酮与HCG联合作为黄体支持会导致黄体期雌二醇和孕酮浓度显著升高。但高浓度的雌二醇似乎对着床过程有有害影响，导致妊娠率降低。
