不同内膜准备方案对卵巢储备功能低下患者冻胚移植妊娠结局的影响  

Effect of various endometrial preparation protocols on the clinical outcomes of frozen-thawed embryo transfer cycles in patients with diminished ovarian reserve

作　　者：李赛姣 尚叶 王笑臣[1,2] 尹太郎 杨菁[1,2] LI Sai-jiao;SHANG Ye;WANG Xiao-chen;YIN Tai-lang;YANG Jing(Reproductive Medical Center,Renmin Hospital of Wuhan University,Wuhan 430060;Hubei Clinic Research Center for Assisted Reproductive Technology and Embryonic Development,Wuhan 430060)

机构地区：[1]武汉大学人民医院生殖医学中心,武汉430060 [2]湖北省辅助生育与胚胎发育医学临床研究中心,武汉430060

出　　处：《生殖医学杂志》2021年第5期561-567,共7页Journal of Reproductive Medicine

基　　金：国家自然科学青年基金项目(81701412);中国国家留学基金(201806275007);湖北省自然科学基金(2018CFB491);湖北省卫生健康科研基金项目(WJ2021M158);默克雪兰诺生殖医学基金(MerckSerono_CREATE-2016141)。

摘　　要：目的探讨不同内膜准备方案对卵巢储备功能低下(DOR)患者行冻融胚胎移植(FET)妊娠结局的影响。方法回顾性分析2016年1月至2019年2月在武汉大学人民医院生殖中心行助孕治疗的DOR患者的582个FET周期,根据子宫内膜准备方式分为3组:促性腺激素释放激素激动剂降调节后激素替代周期组(GnRH-a+HRT组,n=153),人工周期组(HRT组,n=314)和自然周期组(NC组,n=115)。比较3种内膜准备方案的FET妊娠结局;再以女方年龄40岁为界,分为≥40岁及<40岁,分别统计分析不同内膜方案的妊娠结局。结果3组DOR患者的年龄、不孕年限、抗苗勒管激素(AMH)、基础FSH(bFSH)及体重指数(BMI)比较均无显著性差异(P>0.05)。3组患者的移植优胚数、移植胚胎数及移植胚胎类型(卵裂期胚胎/囊胚)比例均无显著性差异(P>0.05)。与HRT组相比,GnRH-a+HRT组和NC组的移植日子宫内膜厚度显著增加(P<0.05)。妊娠结局比较显示,GnRH-a+HRT组和HRT组的多胎妊娠率、种植率显著高于NC组(P<0.05)。女方年龄<40岁患者中GnRH-a+HRT组的临床妊娠率、多胎妊娠率、种植率及异位妊娠率均显著高于NC组,HRT组的种植率显著高于NC组(P<0.05);而女方年龄≥40岁的患者中各组间妊娠结局指标比较均无显著性差异(P>0.05)。结论GnRH-a+HRT内膜准备方案可提高DOR患者FET周期的种植率,尤其适用于年龄<40岁的DOR患者,可作为DOR患者有效的FET内膜准备方案。但同时也增加了多胎妊娠率,值得临床注意。Objective:To study the influence of different endometrial preparation protocols on the pregnancy outcomes of frozen-thawed embryo transfer(FET)in the patients with diminished ovarian reserve(DOR).Methods:A retrospective analysis was conducted on 582 FET cycles of DOR patients in Renmin Hospital of Wuhan University.The cycles were divided into three groups:GnRH agonist down-regulation combined with hormone replacement therapy group(GnRH-a+HRT group,n=153)and hormone replacement therapy group(HRT group,n=314),and the natural cycle group(NC group,n=115).The FET pregnancy outcomes of the three endometrial preparation protocols were compared.Then the patients were subdivided into≥40 years group and<40 years group according the female’s age.The pregnancy outcomes with different endometrial protocols were compared between the two groups.Results:Among the three groups of DOR patients,there were no significant differences in age,infertility years,anti-Müllerian hormone(AMH),basic FSH and BMI(P>0.05).There were no significant differences in the number of high-quality embryos,the number of embryos transferred,and the proportion of transferred embryo types(cleavage embryos/blastocysts)among the three groups(P>0.05).The endometrial thickness on the day of transplantation in the GnRH-a+HRT group and the NC group was significantly thicker than that in the HRT group(P<0.05).The multiple pregnancy rate and implantation rate of GnRH-a+HRT group and HRT group were significantly higher than those of NC group(P<0.05).In female age<40 years group,the clinical pregnancy rate,multiple pregnancy rate,implantation rate and ectopic pregnancy rate of the GnRH-a+HRT group were significantly higher than those of the NC group,and the implantation rate of HRT group was significantly higher than that of the NC group(P<0.05).There were no significant differences in the indicators of pregnancy outcome among the three endometrial preparation protocols in the female age≥40 years group(P>0.05).Conclusions:GnRH-a+HRT endometrial preparation pro

关 键 词：卵巢储备功能低下 高龄 冻融胚胎移植 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]