自然周期冻融胚胎移植使用绒促性素诱发排卵后不同胚胎移植时间临床结局比较  

Clinical Outcome Observation of Different Embryo Transfer Time after Ovulation Inducedby Human Chorionic Gonadotrophin in Natural Cycle Frozen-thawed Embryo Transfers

作　　者：尹轶莎 李秋圆 陈圆辉 张翠莲 张少娣 YIN Yisha;LI Qiuyuan;CHEN Yuanhui(Reproductive Center,Peoples Hospital of Henan University,Henan Provincial People's Hospital.Zhengzhou Henan 450003,China)

机构地区：[1]河南大学人民医院河南省人民医院生殖中心,河南郑州450003

出　　处：《实用妇产科杂志》2020年第7期510-514,共5页Journal of Practical Obstetrics and Gynecology

基　　金：国家重点研发计划课题(编号:2018YFC1002106)。

摘　　要：目的:比较自然周期冻融胚胎移植(FET)使用绒促性素(HCG)诱发排卵后不同胚胎移植时间的临床结局,探讨自然周期FET时机。方法:回顾性分析2014年1月至2018年7月于河南省人民医院生殖中心行自然周期使用HCG诱导排卵的FET周期,根据移植胚胎的不同分为卵裂期胚胎(n=522)和囊胚期胚胎(n=251)共773个周期。根据移植日距HCG注射日天数进行分组,以HCG注射日为D0,HCG注射后第3天移植卵裂期胚胎为D3-3组;HCG注射后第4天移植卵裂期胚胎为D4-3组;HCG注射后第5天移植卵裂期胚胎为D5-3组。HCG注射后第5天移植囊胚为D5-5组;HCG注射后第6天移植囊胚为D6-5组;HCG注射后第7天移植囊胚为D7-5组。比较各组一般情况和妊娠结局相关指标,并对妊娠结局指标进行多元Logistic回归分析。结果:移植卵裂期胚胎的D4-3组移植日子宫内膜厚度高于D3-3组与D5-3组,差异有统计学意义(P<0.05);移植囊胚期胚胎的D7-5组优胚移植周期率显著低于D5-5组与D6-5组,差异有统计学意义(P<0.05);将患者体质量指数(BMI)、年龄、移植胚胎数、优胚移植周期率、移植日子宫内膜厚度作为可能对妊娠结局产生影响的混杂因素进行调整后,移植卵裂期胚胎的D3-3组、D4-3组、D5-3组相比较,移植囊胚期胚胎的D5-5组、D6-5组、D7-5组相比较,胚胎种植率、临床妊娠率、异位妊娠率、持续妊娠率、早期流产率差异无统计学意义(P>0.05)。结论:在HCG诱导排卵的自然周期FET中,HCG注射后3~5天移植卵裂期胚胎,5~7天移植囊胚期胚胎均可取得相似的临床结局。Objective:To compare the clinical outcomes of different embryo transfer time after ovulation induced by human chorionic gonadotrophin(HCG)in natural cyclefrozen-thawed embryo transfers(FET),and to explore the optimal time of natural cycle FET.Methods:FET in natural cycleafter ovulation triggered with HCG in the reproductive center of Henan Provincial People′s Hospital from January 2014 to July 2018 were retrospectively analyzed.According to the differences of the transplanted embryos,they were divided into cleavage stage embryo(n=522)or blastocyst stage embryo(n=251)in a total of 773 cycles.Cycles were grouped according to the number of days between transplantation and HCG injection.The injection date of HCG was D0.Group D3-3 was cleavage stage embryo transferred 3 days after HCG injection.Group D4-3 was cleavage stage embryo transferred 4 days after HCG injection.Group D5-3 was cleavage stage embryo transferred 5 days after HCG injection.Group D5-5 was blastocyst stage embryo transferred 5 days after HCG injection.Group D6-5 was blastocyst stage embryo transferred 6 days after HCG injection.Group D7-5 was blastocyst stage embryo transferred 7 days after HCG injection.The general data and pregnancy outcomes were compared among these groups.Multiple logistic regression analysis of pregnancy outcome indexeswas performed.Results:The endometrial thickness at the day of embryo transfer of group D4-3 was higher than group D3-3 and group D5-3(P<0.05).The optimal embryo rate of group D7-5 was significantly lower than that of group D5-5 and group D6-5(P<0.05).After adjusting the factors which could affect the pregnancy outcome including the body mass index of the patients,age,number of embryos transplanted,optimal embryo rate,and endometrial thickness on the day of transplantation,there was no statistically significant difference in implantation rate,clinical pregnancy rate,ectopic pregnancy rate,continuous pregnancy rate and early abortion rate between the group D3-3,group D4-3 and the group D5-3(P>0.05).When comparing

关 键 词：自然周期 冻融胚胎移植 种植窗 

分 类 号：R711.5[医药卫生—妇产科学]