International Journal of Reproductive BioMedicine
International Journal of Reproductive BioMedicine
IJRM
Medical Sciences
http://ijrm.ir
1
admin
2476-4108
2476-3772
10.29252/ijrm
en
jalali
1394
6
1
gregorian
2015
9
1
13
7
online
1
fulltext
en
بررسی مقایسه دیدژسترون خوراکی با پروژسترون واژینال در حمایت از فاز لوتئال در سیکل های IUI : کارآزمایی بالینی تصادفی شده
Comparison of oral dydrogesterone with vaginal progesteronefor luteal support in IUI cycles: a randomized clinical trial
Original Article
Original Article
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مقدمه:</span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">این</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">مطالعه، مزایای استفاده از</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">دیدروژسترون</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">خوراکی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">با</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">پروژسترون</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">واژینال (سیکلوژست) در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">حمایت</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">فازلوتئال</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سیکل های حاملگی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">حاصل از</span></span> <span dir="LTR"><span style="font-size:11.0pt;">IUI</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">مقایسه</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">می</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گردد</span></span><span dir="LTR"><span style="font-size:11.0pt;">.</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> مکمل پروژسترون زمانی که احتمال نقص فاز لوتئال</span></span><span dir="LTR"><span style="font-size:11.0pt;">(LPD) </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> وجود دارد خط اول درمانی است.</span></span><br>
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">هدف:</span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> این مطالعه جهت مقایسه اثر دیدژسترون خوراکی با سیکلوژست واژینال در حمایت از فاز لوتئال در سیکل های </span></span><span dir="LTR"><span style="font-size:11.0pt;">IUI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> بود.</span></span><br>
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مواد و روش ها: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">این</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">مطالعه</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">آینده</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">نگر، تصادفی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">شده</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">و دوسوکور</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">می</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">باشد</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">که</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">مرکز</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">تحقیقات</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">ناباروری</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">مدت زمان اردیبهشت 92 تا اردیبهشت 93 انجام</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">شده</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">است. این مطالعه شامل</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">150</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">زن</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">نابارور</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">با سن کمتر</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">35</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سال</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">می</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">باشد</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">که</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">تحت</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">تحریک</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">تخمک</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گذاری برای</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سیکلهای</span></span><span dir="LTR"><span style="font-size:11.0pt;"> IUI </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">قرار</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گرفته</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">اند</span></span><span dir="LTR"><span style="font-size:11.0pt;">.</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> این بیماران تحت تحریک تخمک گذاری با دیدروژسترون خوراکی (20</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">میلی گرم)</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">به عنوان گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;">A </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> و سیکلوژست</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">واژنینال (400 میلی گرم)</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">به عنوان گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;">B </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> در آماده سازی برای انجام </span></span><span dir="LTR"><span style="font-size:11.0pt;"> IUI</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">قرار گرفتند</span></span><span dir="LTR"><span style="font-size:11.0pt;">.</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> میزان</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">حاملگی بالینی و</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">میزان</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سقط،</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سطح</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سرمی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">پروژسترون</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">فازلوتئال(7</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">روز</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">بعد</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">از</span></span><span dir="LTR"><span style="font-size:11.0pt;"> (IUI </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">و</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">میزان</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">رضایتمندی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">بین گروه 2</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">مقایسه</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">شد</span></span><span dir="LTR"><span style="font-size:11.0pt;">.</span></span><br>
<strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتایج: </span></span></strong><span style="font-family:b mitra;"><span style="font-size:11.0pt;">سطح</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">پروژسترون</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سرم</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">طور</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">معنی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">داری</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;"> A </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بیشتر</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;"> B </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بود</span></span><span dir="LTR"><span style="font-size:11.0pt;"> (P= 0.001) .</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">میزان</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">باروری</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;"> A </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">تفاوت معنی داری</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">با</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;"> B </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نداشت</span></span><span dir="LTR"><span style="font-size:11.0pt;">(P=0.582) </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">. اگرچه</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">میزان</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سقط</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;"> B </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بیشتر</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">از</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;"> A </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بود</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">ولی میزان</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">سقط</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">هر</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">دو</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">تفاوت</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">معنی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">داری</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">نداشت</span></span><span dir="LTR"><span style="font-size:11.0pt;">(P=0.056) </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">.</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">میزان</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">رضایتمندی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">به</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">طور</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">معنی</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">داری</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">در گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;"> A </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">مقایسه</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">با</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه</span></span><span dir="LTR"><span style="font-size:11.0pt;"> B </span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بیشتر</span></span> <span style="font-family:b mitra;"><span style="font-size:11.0pt;">بود </span></span><span dir="LTR"><span style="font-size:11.0pt;">(P<0.001)</span></span><span style="font-family:b mitra;"><span style="font-size:11.0pt;">.</span></span><span dir="LTR"><span style="font-size:11.0pt;"></span></span><br>
<strong><span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نتیجه گیری: </span></span></span></strong><span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">ما</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">نشان</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">دادیم</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">که</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">دیدروژسترون</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">خوراکی</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">و</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">پروژسترون</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">واژینال (سیکلوژست) در</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">حمایت</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">از</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">فازلوتئال</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">در سیکلهای</span></span></span><span style="font-family:times new roman,serif;"><span style="font-size:11.0pt;"> IUI </span></span><span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">به</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">یک</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">اندازه</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">مؤثر</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">هستند</span></span></span><span style="font-family:times new roman,serif;"><span style="font-size:11.0pt;">.</span></span><span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;"> علاوه</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بر</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">این</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">سطح</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">پروژسترون</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">سرم</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">و</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">میزان</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">رضایتمندی</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">در</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه دیدروژسترون</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">خوراکی</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بیشتر</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">از</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">گروه</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">پروژسترون</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">واژینال</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">بوده</span></span></span> <span dir="RTL"><span style="font-family:b mitra;"><span style="font-size:11.0pt;">است</span></span></span><span style="font-family:times new roman,serif;"><span style="font-size:11.0pt;">.</span></span>
<strong>Background:</strong> The aim of this study, we have compared the advantages of oral dydrogestrone with vaginal progesterone (cyclogest) for luteal support in intrauterine insemination (IUI) cycles. Progesterone supplementation is the first line treatment when luteal phase deficiency (LPD) can reasonably be assumed.<br>
<strong>Objective:</strong> This study was conduct to compare the effect of oral dydrogestrone with vaginal Cyclogest on luteal phase support in the IUI cycles.<br>
<strong>Materials and Methods: </strong>This prospective, randomized, double blind study was performed in a local infertility center from May 2013 to May 2014. It consisted of 150 infertile women younger than35years old undergoing ovarian stimulation for IUI cycles. They underwent ovarian stimulation with oral dydrogesterone (20 mg) as group A and vaginal cyclogest (400 mg) as group B in preparation for the IUI cycles. Clinical pregnancy and abortion rates, mid luteal progesterone (7daysafter IUI) and patient satisfaction were compared between two groups.<br>
<strong>Results: </strong>The mean serum progesterone levels was significantly higher in group A in comparison with group B (p=0.001). Pregnancy rates in group A was not statistically different in comparison with group B (p =0.58). Abortion rate in two groups was not statistically different (p =0.056) although rate of abortion was higher in group B in comparison with A group. Satisfaction rates were significantly higher in group A compared to group B (p<0.001).<br>
<strong>C</strong><strong>onclusion: </strong>We concluded that oral dydrogestrone is effective as vaginal progesterone for luteal-phase support in woman undergoing IUI cycles.<br>
Moreover, the mean serum progesterone levels and satisfaction rates in dydrogestrone group were higher than cyclogest group.
پروژستین, فازلوتئال, هورمونهای تخمدانی.
Progestins,Luteal-phase,Gonadal hormones.
433
438
http://ijrm.ir/browse.php?a_code=A-10-1-218&slc_lang=en&sid=1
Donya
Khosravi
دنیا
خسروی