广西医学

目的比较卵巢功能正常患者在高孕激素状态下促排卵（PPOS）方案中，地屈孕酮和醋酸甲羟孕酮对于辅助生殖技术助孕临床结局的影响。方法回顾性分析335例接受辅助生殖技术治疗并采用PPOS方案的患者的临床资料，根据患者使用的孕激素制剂种类分为醋酸甲羟孕酮组（n=269）和地屈孕酮组（n=66）。按照3∶1比例进行倾向性得分匹配（PSM）后，比较两组患者的一般资料、促排卵周期相关指标和冷冻胚胎移植周期相关指标。结果 PSM后，两组患者一般情况比较，差异无统计意义（P>0.05）。地屈孕酮组的获卵数、第二次减数分裂中期（MⅡ）卵数、受精卵子数、双原核数、可移植胚胎数、可移植胚胎率多于或高于醋酸甲羟孕酮组，优质胚胎率低于醋酸甲羟孕酮组（P<0.05），而两组的优质胚胎数、MⅡ卵率、正常受精率及卵裂率差异无统计学意义（P>0.05）。地屈孕酮组使用自然周期或微刺激周期的患者比例高于醋酸甲羟孕酮组（P<0.05），而两组患者移植日子宫内膜厚度、移植胚胎个数、移植胚胎期别、着床率、临床妊娠率、单胎妊娠率、多胎妊娠率、早期流产率和活产率比较，差异无统计学意义（P>0.05）。结论对于卵巢功能正常的患者，醋酸甲羟孕酮和地屈孕酮均可作为PPOS方案的有效选择。

Objective To compare the effects of dydrogesterone and medroxyprogesterone acetate on clinical outcomes of assisted reproductive technology in patients with normal ovarian function undergoing the progestin⁃primed ovarian stimulation (PPOS) regimen. Methods A retrospective analysis was performed on clinical data of 335 patients who received assisted reproductive technology for treatment with the PPOS regimen. Patients were assigned to medroxyprogesterone acetate group (n=269) or dydrogesterone group (n=66) according to the type of progestogen preparations administered. According to the propensity score matching (PSM) with a 3∶1 matching ratio, general data, ovulation stimulation cycle⁃related parameters, and frozen embryo transfer cycle⁃related indicators were compared between the two groups. Results After PSM, there was no statistically significant difference in general status between the two groups (P>0.05). Compared with the medroxyprogesterone acetate group, the dydrogesterone group exhibited more numbers of retrieved oocytes, metaphase Ⅱ(MⅡ) oocytes, fertilized oocytes, two pronuclei, transferable embryos, and a higher transferable embryo rate, while the high⁃quality embryo rate was lower (P<0.05). No statistically significant difference was observed in the number of high⁃quality embryos, MⅡ oocyte rate, normal fertilization rate, or cleavage rate between the two groups (P>0.05). The proportion of patients undergoing natural or mild stimulation cycles was higher in the dydrogesterone group than in the medroxyprogesterone acetate group (P<0.05). However, there was no statistically significant difference in endometrial thickness on the transfer day, number of transferred embryos, stage of transferred embryos, implantation rate, clinical pregnancy rate, singleton pregnancy rate, multiple pregnancy rate, early abortion rate, or live birth rate between the two groups (P>0.05). Conclusion Both medroxyprogesterone acetate and dydrogesterone are effective options for the PPOS regimen in patients with normal ovarian function.