自然周期和激素替代子宫内膜准备方案对RIF患者种植窗口期子宫内膜容受性的影响  

Effect of Natural Cycle and Endometrial Preparation Program of Hormone Replacement Therapy on Endometrial Receptivity in Patients with RIF during Implantation Window Phase

作　　者：周娟 王春佟 霍安妮 ZHOU Juan;WANG Chun-tong;HUO An-ni(Department of Gynecology,Hanzhong 3201 Hospital,Hanzhong,Shaanxi 723000,China)

机构地区：[1]汉中三二〇一医院妇科,陕西汉中723000

出　　处：《解放军医药杂志》2021年第12期96-100,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：陕西省科技厅科研基金资助项目(2018489)。

摘　　要：目的探讨自然周期(NC)和激素替代(HRT)子宫内膜准备方案对反复种植失败(RIF)患者种植窗口期子宫内膜容受性的影响。方法回顾性分析2017年9月—2020年9月行冻融胚胎移植的RIF 162例的临床资料。依据内膜准备方式分为NC组94例、HRT组68例,分析两种不同子宫内膜准备方案对RIF患者种植窗口期子宫内膜容受性、性激素水平、移植周期特征的影响,并观察妊娠结局。结果准备后2组子宫内膜厚度大于准备前,子宫内膜类型A型占比及子宫内膜下血流高于准备前,且NC组子宫内膜厚度大于HRT组、子宫内膜类型A型占比及子宫内膜下血流均高于HRT组(P<0.05)。准备后2组卵泡刺激素、促黄体生成素、雌二醇水平均较准备前降低,且NC组高于HRT组(P<0.05,P<0.01)。2组移植周期D3胚胎占比、囊胚、移植胚胎数、优质胚胎率、转化日内膜厚度比较差异无统计学意义(P>0.05)。NC组间质、腺体中整合素α_(V)、整合素β_(3)表达水平均高于HRT组,但间质、腺体中雌激素受体、孕激素受体、雄激素受体表达水平均低于HRT组(P<0.01)。2组均无死胎或畸形,且临床妊娠、生化妊娠、早产发生率比较差异无统计学意义(P>0.05),但NC组流产发生率低于HRT组,足月分娩率高于HRT组(P<0.05)。结论NC子宫内膜准备方案对提高子宫内膜容受性效果更好,足月分娩率更高,流产率更低,可成为RIF患者子宫内膜准备理想方案。Objective To explore the effect of natural cycle(NC)and endometrial preparation program of hormone replacement therapy(HRT)on endometrial receptivity(ER)in patients with repeated implantation failure(RIF)during implantation window phase.Methods Clinical data of 162 patients with RIF who had undergone freeze-thaw embryo transfer between September 2017 and September 2020 was retrospectively analyzed.According to methods of endometrial preparation,the patients were divided into NC group(n=94)and HRT group(n=68).Effects of two different methods of endometrial preparation on endometrial receptivity,sex hormone level and transplantation cycle characteristics of RIF patients during implantation window phase were analyzed,and the pregnancy outcomes were observed.Results After preparation,values of endometrial thickness,proportions of type A endometrium and subendometrial blood flow were significantly higher than those before preparation in two groups;the above three indexes in NC group were significantly larger or higher than those in HRT group(P<0.05).After preparation,levels of follicle stimulating hormone(FSH),luteinizing hormone and estradiol were significantly decreased compared with those before preparation in two groups,and the above levels in NC group were significantly higher than those in HRT group(P<0.05,P<0.01).No significant differences were found in ratio of D3 embryos,blastocysts,number of transplanted embryos,rate of high-quality embryos,and endometrial thickness on the transformation day between two groups(P>0.05).In NC group,expressions of integrinα_(V) and integrin β_(3) in stroma and glands were significantly higher,but levels of estrogen receptor(ER),progesterone receptor(PR)and androgen receptor(AR)in stroma and glands were significantly lower than those in HRT group(P<0.01).There were no stillbirths or deformities in two groups,and no significant differences were found in incidence rates of clinical pregnancy,biochemical pregnancy and premature delivery between two groups(P>0.05).Compared with th

关 键 词：胚胎移植 子宫内膜容受性 卵泡刺激素 促黄体生成素 受体 雌激素 激素替代疗法 妊娠结局 

分 类 号：R321.3[医药卫生—人体解剖和组织胚胎学]