冻融胚胎移植周期中围种植期雌二醇监测的意义  

Value of monitoring serum estradiol level during the peri-implantation period in frozen thawed embryo transfer cycle

作　　者：姬萌霞 邢莉莉 金碧辉[1] 余芝芝 傅晓华[1] 吴瑞芳 黄琼晓[1] 舒静[1] JI Meng-xia;XING Li-li;JIN Bi-hui;YU Zhi-zhi;FU Xiao-kua;WU Rui-fang;HUANG Qiong-xiao;SHU Jing(Department of Reproductive Endocrinology,Zhejiang Provincial of Hangzhou Medical College,Hangzkou 310014)

机构地区：[1]浙江省人民医院/杭州医学院附属人民医院生殖内分泌科,杭州310014

出　　处：《生殖医学杂志》2018年第10期976-980,共5页Journal of Reproductive Medicine

摘　　要：目的探讨冻融胚胎移植周期中围种植期血清雌二醇(E2)水平对种植率和妊娠结局的预测价值。方法回顾性分析2016年1月至2017年12月在浙江省人民医院生殖中心行冻融胚胎移植的362个周期,根据不同内膜准备方案分为激素替代方案(239个周期)和自然周期方案(123个周期)。根据妊娠结局的不同,分别比较激素替代方案和自然周期方案中妊娠组与未妊娠组移植日、移植后第3天血清E2和孕酮(P)水平及P/E2;再将患者分为移植后第3天E2≤367pmol/L和E2>367pmol/L两组,比较两组的种植率与妊娠率。结果 (1)激素替代方案中,妊娠组(128个周期)与未妊娠组(111个周期)在移植日、移植后第3天的E2、P及P/E2均无显著差异(P>0.05);移植后第3天E2≤367pmol/L(42个周期)和E2>367pmol/L(197个周期)两组间种植率与妊娠率无显著差异(P>0.05)。(2)自然周期方案中,妊娠组(70个周期)与未妊娠组(53个周期)移植日E2、P及P/E2无显著差异(P>0.05);妊娠组移植后第3天E2水平显著高于未妊娠组[(493.9±272.2)pmol/L vs.(395.0±162.9)pmol/L,P<0.05];移植后第3天E2≤367pmol/L组(43个周期)与E2>367pmol/L组(80个周期)比较,胚胎种植率(28.9%vs.44.7%)和临床妊娠率(41.9%vs.65.0%)均显著下降(P<0.05)。结论移植后第3天E2水平可能预测自然周期冻融胚胎移植的妊娠结局,但在激素替代周期中监测意义不大。Objective： To explore the value of monitoring serum estradiol level in frozen thawed embryo transfer cycles. Methods： The data of 362 frozen embryo transfer（FET）cycles in ＂the reproductive center of Zhejiang Province People＇s Hospital from January 2016 to December 2017 were retrospectively analyzed. According to endometrium preparation protocols,the cycles were divided into hormone replacement（HRT）group（n= 239） and natural cycle （NC） group （n = 123 ）. Serum estradiol （ E2 ）, progesterone （P） levels and P/E2 were compared between in the pregnancy group and the non pregnancy group of the two groups respectively. Then,the patients were divided into groups of E2≤ 367 pmol/L and E2〉367 pmol/L on the third day after embryo transfer. Implantation and pregnancy rates were compared between the two groups. Results： In the HRT group, there was no significant difference in E2, P and P/E2 on the embryo transfer day or the third day after embryo transfer between the pregnancy group （n= 128）and non pregnancy group（n=111）（P〉0.05）. There was no significant difference in the implantation rate and pregnancy rate between E2≤367 pmol/L（n= 42） and E2 〉367 pmol/L（n= 197） （P〉0.05）. In the natural cycle group,there was no significant difference in E2, P and P/E2 on the embryo transfer day between pregnancy group（n=70）and nompregnancy group（n=53）（P〉0.05）. The E2 level [（493. 9±272.2）pmol/L] on the third day after embryo transfer in pregnancy group were significantly higher than that in the non pregnancy group E（395.0 ± 162.9） pmol/L] （P〈0.05）. Moreover, the implantation rate（28.9% vs. 44.7%） and clinical pregnancy rate（41.9% vs. 65.0%）（P〈0.05）were significantly lower in E2≤367 pmol/L group（n=43）than that in E2〉367 pmol/L group（n=80）（P〈0.05）.

关 键 词：冻融胚胎移植 激素替代周期 自然周期 围种植期 雌二醇 

分 类 号：R714.8[医药卫生—妇产科学]