IVF-ET患者黄体支持加用雌激素对妊娠结局的影响—回顾性队列研究

发布时间：2018-06-02 12:24

本文选题：体外受精-新鲜胚胎移植 + 妊娠结局　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:研究体外受精一新鲜胚胎移植(IVF—ET)患者黄体支持加用雌激素对妊娠结局的影响,为个性化制定黄体支持方案提供依据。方法:回顾性分析2010年1月至2015年1月浙江大学医学院附属妇产科医院IVF—ET黄体支持中加用雌激素的患者2115例,按照年龄、体重指数、移植日内膜厚度、胚胎移植数匹配,同期仅用黄体酮行黄体支持的IVF-ET患者4230例作为对照组。(1)通过二元logistic回归分析,比较仅用黄体酮与黄体酮加用雌激素两组间妊娠结局,探讨影响结果的关键因素。(2)进一步按扳机日雌激素水平进行亚组分层,比较不同雌激素峰值下,加用雌激素对妊娠结局的影响。(3)将上述在我院单胎分娩的患者按照是否加用雌激素分为两组,比较两组间在不同扳机日雌激素峰值下,妊娠期及分娩期并发症的发病差异。结果:(1)共6345位患者的6345例周期纳入分析,其中仅用黄体酮支持的患者4230例,黄体酮加用雌激素的患者2115例。利用二元logistic回归发现加用雌激素(OR=0.899,95%CI:0.802～1.008)不是影响临床妊娠的独立因素,加用雌激素(OR= 1.379,95%CI:1.078～1.764)是影响早产发生的独立因素。(2)黄体酮加用雌激素仅在扳机日雌激素介于5000-10000pmol/L水平的患者中是早产的独立危险因素(OR=1.436,95%CI:1.028～2.008)。(3)对于单胎活产的患者,在扳机日雌激素水平介于5000-10000pmol/L范围内加用雌激素,前置胎盘、妊娠期高血压的发病率更高,但差异无统计学意义(P0.05)。结论:体外受精—新鲜胚胎移植周期患者黄体支持方案期加用雌激素不能明显改善临床妊娠率。对于在扳机日雌激素介于5000-10000pmol/L水平的患者,黄体支持方案加用雌激素可能增加早产的风险。对于单胎活产的患者,加用雌激素未明显增加或降低妊娠期及分娩期并发症的发生。
[Abstract]:Aim: to study the effect of luteal support plus estrogen on pregnancy outcome in IVF-ETS patients, and to provide evidence for individualized luteal support scheme. Methods: from January 2010 to January 2015, 2115 cases of IVF-ET luteal body support with estrogen were analyzed retrospectively according to age, body mass index, thickness of endometrium and number of embryo transfer. During the same period, 4230 IVF-ET patients with luteal support were treated with progesterone as control group. The pregnancy outcomes were compared by using progesterone and progesterone plus estrogen by binary logistic regression analysis. To explore the key factors influencing the results. (2) further stratify the subgroups according to the daily estrogen level of the trigger, and compare the different peak estrogen levels. The effect of estrogen addition on pregnancy outcome.) the patients who were delivered in our hospital were divided into two groups according to whether estrogen was added or not. The differences of complications in pregnancy and delivery were compared between the two groups under the peak value of estrogen on different trigger day. Results 6345 cases of 6345 patients were included in the analysis, including 4230 patients supported by progesterone and 2115 patients treated with progesterone plus estrogen. By using binary logistic regression, it was found that the addition of estrogen 0.899 ~ 95% CI: 0.802 ~ 1.008) was not an independent factor affecting clinical pregnancy. Progesterone plus estrogen is an independent risk factor for preterm labor only in patients whose estrogen level is at the level of 5000-10000pmol/L on the trigger day, OR1.43695 CIW 1.0282.008.3) for patients with a single live birth, the risk factor for preterm labor is OR 1.436 / 95 CI: 1.0282.008.3) for patients with single birth, progesterone plus estrogen is an independent risk factor for preterm delivery only in those patients whose estrogen level is at the level of estrogen on the trigger day, and the risk factor for preterm delivery is OR1.436 / 95CIW 1.0282.008.3) The incidence of hypertension in pregnancy was higher than that in the range of 5000-10000pmol/L, placenta previa and gestational hypertension, but the difference was not statistically significant (P 0.05). Conclusion: in vitro fertilization-fresh embryo transfer cycle patients with luteal support regimen plus estrogen can not significantly improve the clinical pregnancy rate. For patients with estrogen at 5000-10000pmol/L levels on the trigger day, the addition of estrogen to the luteal support regimen may increase the risk of preterm labor. For patients with single live birth, estrogen administration did not significantly increase or decrease the incidence of complications during pregnancy and delivery.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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