Objective: To explore the preferable luteal phase support method in artificial insemination therapy.Methods: A total of 172 artificial insemination cycles in our reproductive center were randomly assigned to receive one of 3 different luteal phase support methods 3 days after ovulation: human chorionic gonadotropin (hCG) injection (group A), hCG + progesterone (P) injection (group B) or progesterone capsule (group C).Serum levels of estradiol (E2) and P were consecutively measured in early follicular phase (day 2 of menstrual cycle), ovulation phase (day of hCG administration), and 3, 6, 9 and 16 days after ovulation, and if pregnant, in early pregnancy, middle pregnancy and late pregnancy as well.The pregnancy rate were compared among three groups.Results: The pregnancy rate in group B (hCG+P injection) was higher than that in group A (hCG injection, P＜0.05).There was no significant difference in pregnancy rate between group A and C or between group B and C.Serum levels of progesterone in group C at 6, 9 and 16 days after ovulation were significantly higher than those in group A or group B.There was no significant difference in serum progesterone levels at each time point between group A and group B.The E2/P ratios in group B were most similar to those of normal pregnant women.Conclusions: The pregnancy rate in group B (hCG+P injection) was the highest among 3 groups and the E2/P ratios in group B most resembled those in normal pregnant women.An ideal luteal phase support should not only increase the progesterone levels but also maintain a rational E2/P ratio.%目的 探讨不同黄体支持方法与人工授精的妊娠结局及妊娠周期雌二醇(E2)、孕酮(P)、E2/P动态变化规律,黄体支持中合理的E2/P比值,确定合理的黄体支持方法.方法 对接受供精人工授精促排卵助孕治疗的患者172个治疗周期随机分成3组,分别在排卵后第3天开始接受人绒毛膜促性腺激素(hCG)注射(A组),hCG+黄体酮注射(B组)和口服黄体酮胶囊(C组)三种不同黄体支持方法,比较三者的妊娠结局,连续检测妊娠周期早卵泡期、排卵期(hCG日)、孕卵着床期(窗口期),以及早孕期、孕6、7～8周体内E2、P水平.结果 三种不同黄体支持方法中B组妊娠成功率高于其他两组;排卵用药后各个时期P水平C组最高,A、B两组之间无差异;B组与正常妊娠组E2/P比值及变化趋势最相近.结论 hCG+黄体酮注射组虽无口服黄体酮胶囊组提高P浓度作用显著,但周期妊娠率最高,而且与妊娠对照组E2/P比值及变化趋势最接近,因此在黄体支持不仅要提高P浓度,尚需维持合适的雌孕激素的比值,提示hCG+黄体酮注射是三种方案中的最佳支持方法.
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