1.中山大学孙逸仙纪念医院生殖中心,广东 广州 510120
2.东莞市东部中心医院//暨南大学附属第六医院妇科,广东 东莞 523576
冯书梅,硕士,副主任中医师,研究方向:生殖内分泌助孕,E-mail: fengshumei812@163.com
纸质出版日期:2023-03-20,
收稿日期:2022-09-16,
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冯书梅,潘萍,黄佳等.单纯口服地屈孕酮在自然周期冻融胚胎移植中的临床疗效[J].中山大学学报(医学科学版),2023,44(02):302-309.
FENG Shu-mei,PAN Ping,HUANG Jia,et al.Clinical Efficacy of Oral Dydrogesterone Alone in Natural Cycle Frozen-thawed Embryo Transfer[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(02):302-309.
冯书梅,潘萍,黄佳等.单纯口服地屈孕酮在自然周期冻融胚胎移植中的临床疗效[J].中山大学学报(医学科学版),2023,44(02):302-309. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0215.
FENG Shu-mei,PAN Ping,HUANG Jia,et al.Clinical Efficacy of Oral Dydrogesterone Alone in Natural Cycle Frozen-thawed Embryo Transfer[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(02):302-309. DOI: 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0215.
目的
2
探讨单纯口服地屈孕酮在自然周期冻融胚胎移植(NC-FET)中黄体支持的临床疗效。
方法
2
回顾性分析2019年1月至2021年9月在中山大学孙逸仙纪念医院生殖中心行NC-FET周期的临床资料,共1 530个治疗周期。根据不同黄体支持方案分为三组:A组单纯口服地屈孕酮片(
n
=524),B组阴道用黄体酮软胶囊(
n
=401),C组A+B联合用药(
n
=605),比较三种黄体支持患者的临床结局和成本-效果比。主要观察指标是活产率。
结果
2
活产率A组43.13%(226/524)、B组39.15%(157/401)、C组42.64%(258/605),组间比较差异无统计学意义(
P
>0.05),三组患者HCG阳性率、胚胎种植率、生化妊娠率、临床妊娠率、自然流产率、异位妊娠率、双胎分娩率、早产率和新生儿体质量均差异无统计学意义(
P
>0.05)。logistic回归分析显示:三种黄体支持方案不影响活产率结果。从药物经济学分析,以B组为参照,A组每增加1%活产率,费用增加19 227.30元。
结论
2
在NC-FET周期中,单纯口服地屈孕酮可获得与阴道用黄体酮软胶囊及联合用药相似的临床结局,与阴道用黄体酮软胶囊相比,单纯口服地屈孕酮黄体支持的成本有增加,但仍需大样本和多中心的前瞻性研究来验证。
Objective
2
To investigate the clinical efficacy of oral dydrogesterone alone for luteal phase support in natural cycle frozen-thawed embryo transfer (NC-FET).
Methods
2
The clinical data of 1 530 NC-FET cycles enrolled in our Reproductive Center from January 2019 to September 2021 were retrospectively analyzed. According to different luteal support protocols, the patients were divided into oral dydrogesterone alone (group A,
n
=524), vaginal progesterone soft capsules (group B,
n
=401) and vaginal progesterone soft capsules combined with dydrogesterone (group C,
n
=605). The clinical outcomes and cost-effectiveness ratio were compared among the three groups. The primary outcome was live birth rate.
Results
2
The live birth rate was 43.13% (226/524) in group A, 39.15% (157/401) in group B, and 42.64% (258/605) in group C. There was no statistical difference among the three groups (
P
>
0.05). No statistical difference was observed in the HCG positive rate, implantation rate, biochemical pregnancy rate, clinical pregnancy rate, spontaneous miscarriage rate, ectopic pregnancy rate, twin delivery rate, premature delivery rate and newborn weight among the three groups (
P
>
0.05). Logistic regression analysis revealed that the three luteal support regimens did not affect live birth rate. Pharmacoeconomic analysis showed that taking group B as a reference, the cost increased by 19 227.30 yuan for every 1% increase in live birth rate in group A.
Conclusions
2
In NC-FET cycle, oral dydrogesterone alone can achieve the same clinical outcomes as vaginal progesterone soft capsules and vaginal progesterone soft capsules combined with dydrogesterone. Compared with that of progesterone soft capsules, the cost of oral dydrogesterone alone is increased, a large sample and multicenter prospective study is needed to further confirm our results.
冻融胚胎移植自然周期黄体支持妊娠结局成本-效果比
frozen-thawed embryo transfer (FET)natural cycleluteal phase supportpregnancy outcomescost-effectiveness ratio
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