两种非依赖内源性卵巢周期的内膜准备方案对薄型子宫内膜冻融胚胎移植患者妊娠结局的影响研究  

Influence of Two Endometrial Preparation Programs Independent of Endogenous Ovarian Cycle on the Pregnancy Outcome of Thin Endometrial Patients with Freeze-thaw Embryo Transfer

作　　者：魏珑珑 张翠莲[1] WEI Longlong;ZHANG Cuilian(Reproductive Medicine Center of Henan Provincal People's Hospital,Zhengzhou 450052,China)

机构地区：[1]河南省人民医院生殖医学研究所,河南省郑州市450052

出　　处：《中国全科医学》2022年第3期269-274,共6页Chinese General Practice

基　　金：2020年度河南省医学科技攻关计划省部共建重大项目(SBGJ202001002)。

摘　　要：背景薄型子宫内膜是导致患者妊娠率降低的重要原因之一。全胚冷冻是薄型子宫内膜患者助孕过程中的重要策略,对于其后的冻融胚胎移植方案的选择尚存争议。目的探讨在薄型子宫内膜患者中两种非依赖内源性卵巢周期的内膜准备方案,即人工周期和促性腺激素释放激素激动剂(GnRH-a)降调节人工周期中妊娠结局的差异。方法回顾性分析2016年12月至2019年7月于河南省人民医院生殖中心接受体外受精/卵胞质内单精子显微注射胚胎移植(IVF/ICSI-ET)助孕治疗,取卵当月因子宫内膜厚度≤7 mm进行全胚冷冻,后采用人工周期(人工周期组,n=409)和GnRH-a降调节人工周期(GnRH-a降调节人工周期组,n=103)进行冻融胚胎移植患者的临床资料。比较两组患者妊娠结局。结果人工周期组患者平均移植胚胎(1.60±0.49)枚,GnRH-a降调节人工周期组患者平均移植胚胎(1.66±0.52)枚,两组比较差异无统计学意义(P>0.05)。两组临床妊娠率、着床率、流产率、异位妊娠率及多胎率比较,差异均无统计学意义(P>0.05)。人工周期组中,移植1枚、2枚、3枚胚胎者临床妊娠率、着床率、流产率、异位妊娠率及多胎率比较,差异均无统计学意义(P>0.05);GnRH-a降调节人工周期组中,移植1枚、2枚、3枚胚胎者临床妊娠率、着床率、流产率、异位妊娠率及多胎率比较,差异均无统计学意义(P>0.05)。结论子宫内膜厚度≤7 mm的薄型子宫内膜患者中两种非依赖内源性卵巢周期的内膜准备方案即人工周期和GnRH-a降调节人工周期妊娠结局相似,不建议在无子宫内膜异位症、反复种植失败等特殊病史的常规薄型子宫内膜患者群体中使用GnRH-a联合激素替代的内膜准备方案。Background Thin endometrium is one of the crucial reasons leading to the reduction of pregnancy rate in patients.The whole embryo freezing is an important strategy in the process of assisting pregnancy in patients with thin endometrium.However,there are still controversies regarding the choice of subsequent freeze-thaw embryo transfer.Objective To explore the difference between two endometrial preparation programs〔artificial cycle and gonadotropin releasing hormone agonist(GnRH-a)down regulating artificial cycle〕independent of endogenous ovarian cycle in patients with thin endometrial.Methods A retrospective analysis of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)assisted pregnancy treatment was performed in the Reproductive Center of Henan Provincial People's Hospital from December 2016 to July 2019.The whole embryo was frozen due to endometrial thickness less than 7 mm in the month of egg collection,then the clinical data of the freezing-thawing embryo transfer patients were collected by artificial cycle(artificial cycle group,n=409)and GnRH-a down-regulated artificial cycle(GnRH-a down-regulated artificial cycle group,n=103).Pregnancy results were compared between the two groups of patients.Results The average number of transplanted embryos in the artificial cycle group was(1.60±0.49),while that in the GnRH-a daon-regulated artificial cycle group was(1.66±0.52),and there was no statistically significant difference between the two groups(P>0.05).In the artificial cycle group,there were no significant differences in clinical pregnancy rate,implantation rate,abortion rate,ectopic pregnancy rate and multiple pregnancy rate among those with 1,2 and 3 embryos transferred,respectively(P>0.05).In the GnRH-a down-regulated artificial cycle group,there were also no significant differences in clinical pregnancy rate,implantation rate,abortion rate,ectopic pregnancy rate and multiple fetus rate among those with 1,2 and 3 embryos transferred,respectively(P>0.05).Conclusion In p

关 键 词：子宫疾病 薄型子宫内膜 胚胎移植 移植胚胎数 妊娠率 月经周期 

分 类 号：R711.22[医药卫生—妇产科学]