Objective: Comparison of vaginal progesterone (VP) versus VP and intermittent intramuscular progesterone (IMP) use in frozen/thawed blastocyst transfer cycles. Study Design: A single center retrospective analyses of 4...Objective: Comparison of vaginal progesterone (VP) versus VP and intermittent intramuscular progesterone (IMP) use in frozen/thawed blastocyst transfer cycles. Study Design: A single center retrospective analyses of 470 elective FET cycles which were performed between January 2015 and September 2019 were evaluated. Patients were divided into two groups. Control group was consisted of VP (n = 272), the study group was consisted of VP plus IMP (n = 198) users. Results: The number of transfer attempts in control and study groups was 272 and 198, respectively. Age (29.8 ± 4 vs 30.6 ± 4;p = 0.09), BMI (22 ± 2 vs 21.9 ± 3;p = 0.79) and the number of transferred embryos (1.4 ± 0.5 vs 1.4 ± 0.5;p = 0.48) were comparable between groups. Altough, implantation rates (43.7% vs 43.6%;p = 0.9), ectopic pregnancy (0.8% vs 0.3%;p = 0.46) and abortion rates (8.2% vs 4.8%;p = 0.07) were similar. Biochemical pregnancy rate (8.4% vs 3.4% p = 0.01) in control group and ongoing pregnancy rate (OPR) (27.9% vs 38.1%;p = 0.005) in study group were significantly higher. Conclusion: Within the FET cycles in which good quality blastocyst are being transferred additional IMP supplementation to VP may increase OPR while reducing the biochemical pregnancy rate.展开更多
Background：Preterm birth （PTB） is the leading cause of perinatal morbidity and mortality worldwide,and its prevention is an important health-care priority.The cervical incompetence is a well-known risk factor for P...Background：Preterm birth （PTB） is the leading cause of perinatal morbidity and mortality worldwide,and its prevention is an important health-care priority.The cervical incompetence is a well-known risk factor for PTB and its incidence is about 0.1-2.0%,while there is no ideal optimum treatment recommended currently.The cervical incompetence causes about 15% of habitual abortion in 16-28 weeks.This study aimed to evaluate the effectiveness and safety of cervical cerclage and vaginal progesterone in the treatment of cervical incompetence with/without PTB history.Methods：We retrospectively observed the pregnancy outcome of 198 patients diagnosed with cervical incompetence from January 2010 to October 2015 in Beijing Hospital.Among the 198 women involved,women who had at least one PTB before 32 weeks （including abortion in the second trimester attributed to the cervical competence） were assigned to the PTB history cohort,and others were assigned to the non-PTB history cohort.All women underwent cerclage placement （cervical cerclage group） or administrated with vaginal progesterone （vaginal progesterone group） until delivery.The outcomes of interest were the differences in gestational age at delivery,the rate of premature delivery,neonatal outcome,complications,and route of delivery between the two treatment groups.Results：Among the 198 patients with cervical incompetence,116 patients in PTB history cohort and 80 patients in non-PTB history cohort were included in the final analysis.In the PTB history cohort,cervical cerclage group had significantly longer cervical length at 2 weeks after the start of treatment （23.1 ± 4.6 mm vs.12.4 ± 9.1 mm,P =0.002）,higher proportion of delivery ≥37 weeks＇ gestation （63.4% vs.33.3%,P =0.008）,bigger median birth weight （2860 g vs.2250 g,P =0.031）,and lower proportion of neonates whose 1-min Apgar score 〈7 （5.9% vs.33.3%,P =0.005）,compared with vaginal progesterone group.No significant differences were found in other outcome measures between the two treatment groups.In the non-PTB history cohort,there were no significant differences in the maternal outcomes between cervical cerclage and vaginal progesterone groups,such as median gestational age at delivery （37.4 weeks vs.37.3 weeks,P =0.346） and proportion of delivery ≥37 weeks＇ gestation （55.9% vs.60.9%,P =0.569）.There were also no significant differences in the neonatal outcomes between the cervical cerclage and vaginal progesterone groups including the median birth weight （2750 g vs.2810 g,P =0.145）,perinatal mortality （5.9% vs.6.5%,P =0.908）,and 1-min Apgar scores （8.8% vs.8.7%,P =0.984）.Conclusions：Cervical cerclage showed more benefits in the maternal and neonatal outcomes than vaginal progesterone therapy for women with an asymptomatic short cervix and prior PTB history,while cervical cerclage and vaginal progesterone therapies showed similar effectiveness for women with an asymptomatic short cervix but without a history of PTB.展开更多
Background： Luteal support is a key to patients undergoing in vitro fertilization and embryo transfer （IVF-ET） with gonadotropin-releasing hormone （GnRH）-antagonist protocol. This study aimed to compare the effec...Background： Luteal support is a key to patients undergoing in vitro fertilization and embryo transfer （IVF-ET） with gonadotropin-releasing hormone （GnRH）-antagonist protocol. This study aimed to compare the effect between vaginal progesterone （VP） and intramuscular progesterone （IMP） with GnRH-antagonist protocol alter IVF-ET. Methods： A total of 1760 patients （18 years ≤ age ≤35 years） undergoing IVF-ET with GnRH-antagonist protocol were studied retrospectively between September 2014 and August 2015 in Peking University Third Hospital. In the patients, 1341 patients received VP （VP group） and 419 patients received IMP （IMP group） as luteal support. We compared clinical outcomes between these two groups. The primary objective of the study was the live birth rate. Measurement data between the two groups were conducted using independent samples t-test. The variables in line with non-normal distribution were expressed as median （p25 and p75） and were compared using nonparametric Mann. Whitney U-test. Results： Live birth rate in VP group was 38.55%, significantly higher than that in the IMP group, which was 30.79% （x^2 = 8.287, P= 0.004）. The clinical intrauterine pregnancy rate and implantation rate in VP group were also significantly higher than those in the IMP group （clinical intrauterine pregnancy rate 47.35% vs. 41.29%, x^2= 4.727, P = 0.030： implantation rate 30.99% vs. 25.26%, x^2=14.546, P 〈 0.001）. Any statistically significant differences in ectopic pregnancy and abortion rates between two groups were not observed. Conclusion： Luteal support with VP had better clinical outcomes for young women undergoing IVF-ET with GnRH-antagonist protocol.展开更多
Preterm parturition is the consequence of pathological signals that activate the common pathway of parturition and considered as a syndrome.Many risk factors for spontaneous preterm birth(sPTB)have been identified.Two...Preterm parturition is the consequence of pathological signals that activate the common pathway of parturition and considered as a syndrome.Many risk factors for spontaneous preterm birth(sPTB)have been identified.Two significant risk factors for sPTB are history of prior sPTB and short cervical length at midtrimester.17 hydroxyprogesterone caproate,vaginal progesterone,cerclage,and pessary have all been studied for prevention of sPTB.Difference in patient populations likely contributes to the conflicting study results.Further studies are needed to establish strategies in prevention of sPTB in singleton as well as multiple pregnancies.展开更多
文摘Objective: Comparison of vaginal progesterone (VP) versus VP and intermittent intramuscular progesterone (IMP) use in frozen/thawed blastocyst transfer cycles. Study Design: A single center retrospective analyses of 470 elective FET cycles which were performed between January 2015 and September 2019 were evaluated. Patients were divided into two groups. Control group was consisted of VP (n = 272), the study group was consisted of VP plus IMP (n = 198) users. Results: The number of transfer attempts in control and study groups was 272 and 198, respectively. Age (29.8 ± 4 vs 30.6 ± 4;p = 0.09), BMI (22 ± 2 vs 21.9 ± 3;p = 0.79) and the number of transferred embryos (1.4 ± 0.5 vs 1.4 ± 0.5;p = 0.48) were comparable between groups. Altough, implantation rates (43.7% vs 43.6%;p = 0.9), ectopic pregnancy (0.8% vs 0.3%;p = 0.46) and abortion rates (8.2% vs 4.8%;p = 0.07) were similar. Biochemical pregnancy rate (8.4% vs 3.4% p = 0.01) in control group and ongoing pregnancy rate (OPR) (27.9% vs 38.1%;p = 0.005) in study group were significantly higher. Conclusion: Within the FET cycles in which good quality blastocyst are being transferred additional IMP supplementation to VP may increase OPR while reducing the biochemical pregnancy rate.
文摘Background：Preterm birth （PTB） is the leading cause of perinatal morbidity and mortality worldwide,and its prevention is an important health-care priority.The cervical incompetence is a well-known risk factor for PTB and its incidence is about 0.1-2.0%,while there is no ideal optimum treatment recommended currently.The cervical incompetence causes about 15% of habitual abortion in 16-28 weeks.This study aimed to evaluate the effectiveness and safety of cervical cerclage and vaginal progesterone in the treatment of cervical incompetence with/without PTB history.Methods：We retrospectively observed the pregnancy outcome of 198 patients diagnosed with cervical incompetence from January 2010 to October 2015 in Beijing Hospital.Among the 198 women involved,women who had at least one PTB before 32 weeks （including abortion in the second trimester attributed to the cervical competence） were assigned to the PTB history cohort,and others were assigned to the non-PTB history cohort.All women underwent cerclage placement （cervical cerclage group） or administrated with vaginal progesterone （vaginal progesterone group） until delivery.The outcomes of interest were the differences in gestational age at delivery,the rate of premature delivery,neonatal outcome,complications,and route of delivery between the two treatment groups.Results：Among the 198 patients with cervical incompetence,116 patients in PTB history cohort and 80 patients in non-PTB history cohort were included in the final analysis.In the PTB history cohort,cervical cerclage group had significantly longer cervical length at 2 weeks after the start of treatment （23.1 ± 4.6 mm vs.12.4 ± 9.1 mm,P =0.002）,higher proportion of delivery ≥37 weeks＇ gestation （63.4% vs.33.3%,P =0.008）,bigger median birth weight （2860 g vs.2250 g,P =0.031）,and lower proportion of neonates whose 1-min Apgar score 〈7 （5.9% vs.33.3%,P =0.005）,compared with vaginal progesterone group.No significant differences were found in other outcome measures between the two treatment groups.In the non-PTB history cohort,there were no significant differences in the maternal outcomes between cervical cerclage and vaginal progesterone groups,such as median gestational age at delivery （37.4 weeks vs.37.3 weeks,P =0.346） and proportion of delivery ≥37 weeks＇ gestation （55.9% vs.60.9%,P =0.569）.There were also no significant differences in the neonatal outcomes between the cervical cerclage and vaginal progesterone groups including the median birth weight （2750 g vs.2810 g,P =0.145）,perinatal mortality （5.9% vs.6.5%,P =0.908）,and 1-min Apgar scores （8.8% vs.8.7%,P =0.984）.Conclusions：Cervical cerclage showed more benefits in the maternal and neonatal outcomes than vaginal progesterone therapy for women with an asymptomatic short cervix and prior PTB history,while cervical cerclage and vaginal progesterone therapies showed similar effectiveness for women with an asymptomatic short cervix but without a history of PTB.
基金This study was supported by a grant from the National Natural Science Foundation of Key Program （No. 31230047）.
文摘Background： Luteal support is a key to patients undergoing in vitro fertilization and embryo transfer （IVF-ET） with gonadotropin-releasing hormone （GnRH）-antagonist protocol. This study aimed to compare the effect between vaginal progesterone （VP） and intramuscular progesterone （IMP） with GnRH-antagonist protocol alter IVF-ET. Methods： A total of 1760 patients （18 years ≤ age ≤35 years） undergoing IVF-ET with GnRH-antagonist protocol were studied retrospectively between September 2014 and August 2015 in Peking University Third Hospital. In the patients, 1341 patients received VP （VP group） and 419 patients received IMP （IMP group） as luteal support. We compared clinical outcomes between these two groups. The primary objective of the study was the live birth rate. Measurement data between the two groups were conducted using independent samples t-test. The variables in line with non-normal distribution were expressed as median （p25 and p75） and were compared using nonparametric Mann. Whitney U-test. Results： Live birth rate in VP group was 38.55%, significantly higher than that in the IMP group, which was 30.79% （x^2 = 8.287, P= 0.004）. The clinical intrauterine pregnancy rate and implantation rate in VP group were also significantly higher than those in the IMP group （clinical intrauterine pregnancy rate 47.35% vs. 41.29%, x^2= 4.727, P = 0.030： implantation rate 30.99% vs. 25.26%, x^2=14.546, P 〈 0.001）. Any statistically significant differences in ectopic pregnancy and abortion rates between two groups were not observed. Conclusion： Luteal support with VP had better clinical outcomes for young women undergoing IVF-ET with GnRH-antagonist protocol.
文摘Preterm parturition is the consequence of pathological signals that activate the common pathway of parturition and considered as a syndrome.Many risk factors for spontaneous preterm birth(sPTB)have been identified.Two significant risk factors for sPTB are history of prior sPTB and short cervical length at midtrimester.17 hydroxyprogesterone caproate,vaginal progesterone,cerclage,and pessary have all been studied for prevention of sPTB.Difference in patient populations likely contributes to the conflicting study results.Further studies are needed to establish strategies in prevention of sPTB in singleton as well as multiple pregnancies.
