使用醋酸甲羟孕酮延长黄体期对反复植入失败妇女的子宫内膜厚度和妊娠率的影响

Behnaz Sadeghzadeh Oskouei, Parviz Shahabi, Hossein Babaei, A. Farshbaf-Khalili
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摘要

简介辅助生殖技术(ART)越来越多地用于帮助不育夫妇生育。然而,只有不到三分之一的移植胚胎能成功着床和活产。反复植入失败(RIF)是这一先进技术实现怀孕的一个突出障碍。本研究旨在评估黄体期延长会导致子宫内膜增厚并降低 RIF 发生率的假设。研究方法这项干预研究在伊朗大不里士市阿尔扎赫拉教学医院和阿萨达巴迪综合医院的不孕症诊所进行。通过目的性抽样方法招募了 60 名妇女,年龄在 20-40 岁之间,曾在多个体外受精治疗周期后出现过 RIF,黄体中期孕酮水平低于 3 纳克/毫升,子宫内膜厚度低于 8 毫米。参与者在月经周期的第 16 天开始口服醋酸甲羟孕酮(MPA)片剂 5 毫克/12 小时,共治疗 6 个周期,为期 20 天,并在此期间对研究结果进行评估。对所有研究对象服用 MPA 前后的子宫内膜厚度进行比较。确定妊娠率。在研究期间对妊娠并发症和情况进行了评估。结果服用 MPA 后,患者的子宫内膜厚度有所增加(平均差 [95% CI]:2.66 [2.43 至 2.89];P<0.001)。在为期 6 个月的治疗中,80%(48 人)的参与者实现了生化妊娠。48 人中有 4 人在怀孕的不同阶段失去了妊娠机会。一名参与者在怀孕第 24 周时患上了妊娠糖尿病。直到分娩,胚胎胎儿均未出现异常。结论在 RIF 后服用 MPA 可诱导子宫内膜发育,并通过延长黄体期促进胚胎着床,从而在定时同房后自然怀孕。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The effect of luteal phase prolongation with medroxyprogesterone acetate on endometrial thickness and pregnancy rate in women following recurrent implantation failure
Introduction: Assisted reproductive technology (ART) is increasingly used to help infertile couples to have a child. However, less than one-third of transferred embryos result in successful implantation and live birth. Recurrent implantation failure (RIF) is an outstanding barrier to pregnancy achievement by this advanced technology. This study was conducted to evaluate the hypothesis that luteal phase prolongation would lead to endometrial thickening and decrease the RIF’s rate. Methods: This interventional study was conducted in the infertility clinic of the Alzahra Teaching Hospital and Asadabadi polyclinic, Tabriz, Iran. Sixty women, aged 20–40 years, with a history of RIF following several in vitro fertilization treatment cycles with mid-luteal progesterone levels less than 3 ng/mL, and endometrial thickness less than 8mm were recruited through the purposive sampling method. Participants were treated for six cycles with oral medroxyprogesterone acetate (MPA) tablet 5 mg/12 h initiated from the 16th day of their menstrual cycle for 20 days and evaluated for study outcomes during this course. Endometrial thickness was compared before and after MPA administration in the whole study population. The pregnancy rate was determined. Pregnancy complications and conditions were evaluated during the study. Results: Endometrial thickness was increased in patients after MPA administration (mean difference [95% CI]: 2.66 [2.43 to 2.89]; P<0.001). Overall, 80% (n=48) of participants achieved biochemical pregnancy during a 6-month treatment. Four pregnancies out of 48, were lost in different stages of pregnancy. One participant experienced gestational diabetes in the 24th week of pregnancy. No embryo-fetal abnormality was present until delivery. Conclusion: Administration of MPA following RIF induces endometrial development and facilitates embryo implantation by luteal phase prolongation which results in natural pregnancy achievement followed by timed intercourse.
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