去氧孕烯炔雌醇片预处理联合氯米芬用于宫颈机能不全患者体外受精-胚胎移植的临床研究

Clinical study of deoxypregnene ethinylestradiol tablets pretreatment combined with clomiphene for in vitro fertilization embryo transfer in patients with cervical insufficiency

摘要:

目的 观察去氧孕烯炔雌醇片预处理联合氯米芬用于宫颈机能不全患者体外受精-胚胎移植的临床疗效，并分析其不良妊娠结局的影响因素。方法 将120例拟接受体外受精-胚胎移植的宫颈机能不全患者随机分为观察组和对照组，对照组给予氯米芬微刺激治疗，观察组给予去氧孕烯炔雌醇片预处理联合氯米芬微刺激治疗。比较两组患者的周期取消率、生化妊娠率及临床妊娠率、获卵数、正常受精卵数、早孕期流产率、血清胰岛素样生长因子1（IGF-1）、胰岛素样生长因子结合蛋白3（IGFBP-3）。结果 观察组患者的促性腺激素（GTH）用量、GTH刺激天数少于对照组，人绒毛膜促性腺素（HCG）注射日雌激素值小于对照组，周期取消率、早孕期流产率、晚期流产率、早产率低于对照组（P <0.05），正常受精率、生化妊娠率、临床妊娠率、活产率、A型子宫内膜率高于对照组，获卵数、正常受精卵数多于对照组，扳机日子宫内膜厚度厚于对照组（P <0.05）。观察组患者刺激前后血清IGF-1、IGFBP-3水平的差值大于对照组（P <0.05）。一般Logistic回归分析结果显示，不孕年龄［O^R=0.882（95% CI：0.511，0.999）］、不同刺激方案［O^R=1.062（95% CI：1.001，2.112）］、GTH用量［O^R=0.712（95% CI：0.526，0.941）］、获卵数［O^R=1.122（95% CI：1.022，1.201）］、可利用胚胎数［O^R=2.012（95% CI：1.561，2.300）］是妊娠不良结局的危险因素（P <0.05）。结论 去氧孕烯炔雌醇片预处理联合氯米芬可显著改善患者的IGF-1、IGFBP-3水平及妊娠结局；且可利用胚胎数较多、GTH用量较少的患者，其妊娠结局较好、获卵数较多。

Abstract:

Objective To observe the clinical effect of dexpregnenylestradiol tablets combined with microstimulation program on in vitro fertilization embryo transfer in patients with cervical insufficiency, and to analyze the influencing factors of adverse pregnancy outcome.Methods Totally 120 patients with cervical insufficiency undergoing in vitro fertilization embryo transfer were randomly divided into observation group and control group. The control group was treated with clomiphene micro stimulation, and the observation group was treated with deoxypregnene ethinylestradiol tablets pretreatment combined with clomiphene micro stimulation. The cycle cancellation rate, biochemical pregnancy rate, clinical pregnancy rate, number of retrieved eggs, number of normal fertilized eggs, abortion rate in early pregnancy, serum IGF-1 and IGFBP-3 levels were observed and compared between the two groups.Results The cycle cancellation rate, abortion rate in early pregnancy, late abortion rate, premature delivery rate in the observation group were significantly lower than those in the control group (P < 0.05). Normal fertilization rate, biochemical pregnancy rate, clinical pregnancy rate, number of eggs retrieved, the number of normal fertilized eggs, live birth rate, endometrial thickness on trigger day, and type A endometrial rate were significantly higher than those in the control group (P < 0.05). The difference of serum IGF-1 and IGFBP-3 levels before and after stimulation in the observation group was greater than that in the control group (P < 0.05). Logistic regression analysis showed that infertility age [O^R = 0.882 (95% CI: 0.511, 0.999) ], different stimulation schemes [O^R = 1.062 (95% CI: 1.001, 2.112) ], GTH dosage [O^R = 0.712 (95% CI: 0.526, 0.941) ], number of eggs retrieved [O^R = 1.122 (95% CI: 1.022, 1.201) ], number of available embryos [O^R = 2.012 (95% CI: 1.561, 2.300) ] were risk factors for adverse pregnancy outcomes (P < 0.05).Conclusion Steroid pretreatment combined with clomiphene microstimulation can significantly improve IGF-1, IGFBP-3 levels and pregnancy outcome, and pregnancy outcome is positively related to the number of eggs and embryos available, and negatively related to the total use of GTH.