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Sự kết hợp giữa dydrogesterone và progesterone âm đạo vi hạt có thể làm cho việc đo nồng độ progesterone huyết thanh vào ngày chuyển phôi và các nỗ lực cứu trợ trở nên không cần thiết trong chu kỳ FET HRT
Tóm tắt
Để đánh giá vai trò của progesterone huyết thanh (P4) vào ngày chuyển phôi (ET) khi sử dụng kết hợp dydrogesterone (DYD) và progesterone âm đạo vi hạt (MVP) như hỗ trợ giai đoạn hoàng thể (LPS) trong liệu pháp thay thế hormone (HRT) cho các chu kỳ chuyển phôi đông lạnh (FET). Nghiên cứu hồi cứu, bao gồm các chu kỳ FET HRT đơn euploid với DYD và MVP như LPS và đo P4 vào ngày ET. Ban đầu, những bệnh nhân có mức P4 < 10 ng/ml đã tăng MVP lên 400 mg/ngày; việc “cứu trợ” này sau đó đã bị bỏ giữa chừng. 560 chu kỳ của 507 cặp vợ chồng đã được đưa vào nghiên cứu. Trong số 275 phụ nữ, mức P4 huyết thanh < 10 ng/ml vào ngày ET. Trong số những người có mức P4 thấp, liều MVP không thay đổi ở 65 phụ nữ (11,6%) và đã được tăng lên ở 210 phụ nữ (37,5%). Những phụ nữ có mức P4 ≥ 10 ng/ml tiếp tục LPS mà không có sự thay đổi. Tỷ lệ mang thai tổng thể trong các nhóm này lần lượt là 61,5% (40/65), 54,8% (115/210) và 48,4% (138/285) (p = n.s.). Mối liên quan giữa mức P4 huyết thanh với tỷ lệ mang thai liên tục đã được phân tích ở những phụ nữ không có MVP bổ sung bất kể mức P4 huyết thanh (n = 350); phân tích đa biến (được điều chỉnh theo độ tuổi, BMI, chất lượng phôi (EQ)) không cho thấy sự liên quan đáng kể giữa mức P4 huyết thanh với OPR (OR 0,96, 95% CI 0,90–1,02; p = 0,185). Sử dụng trọng số điều trị xác suất ngược, phân tích hồi quy trong mẫu có trọng số không cho thấy sự liên quan đáng kể giữa các nhóm điều trị P4 và OP. So với EQ trung bình, việc chuyển giao EQ tốt làm tăng cơ hội (OR 1,61, 95% CI 1,22–2,15; p = 0,001) và việc chuyển giao EQ kém làm giảm tỷ lệ OP (OR 0,73, 95% CI 0,55–0,97; p = 0,029). Trong chu kỳ HRT FET, việc sử dụng LPS với 300 mg/ngày MVP và 30 mg/ngày DYD dường như cho thấy việc đo P4 huyết thanh và tăng MVP ở những bệnh nhân có P4 < 10 ng/ml là không cần thiết.
Từ khóa
#progesterone huyết thanh #dydrogesterone #progesterone âm đạo vi hạt #hỗ trợ giai đoạn hoàng thể #chu kỳ chuyển phôi đông lạnhTài liệu tham khảo
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