冻融胚胎移植周期两种内膜准备方案对薄型子宫内膜患者临床妊娠结局的影响  

Effect of Two Endometrial Preparation Protocols on Clinical Pregnancy Outcome of Patients with Thin Endometrium in Frozen Thawed Embryo Transfer Cycle

作　　者：白雪莲 杨泽欣 肖楠 张印峰[2] 张云山[2] BAI Xuelian;YANG Zexin;XIAO Nan(Graduate School,Tianjin Medical University,Tianjin 300070,China;Reproductive Center,Tianjin Central Obstetrics and Gynecology Hospital,Tianjin Key Laboratory of Human Development and Reproductive Regulation,Tianjin 300052,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市中心妇产科医院生殖中心,天津市人类发育与生殖调控重点实验室,天津300052

出　　处：《实用妇产科杂志》2022年第1期53-57,共5页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:探讨薄型子宫内膜(TE)患者冻融胚胎移植(FET)周期中两种内膜准备方案对妊娠结局的影响。方法:采用回顾性病例对照研究设计,分析2016年1月至2020年5月于天津市中心妇产科医院体外受精/卵胞浆内单精子显微注射(IVF/ICSI)治疗,扳机日子宫内膜厚度(EMT)≤7 mm,并行FET的319个周期,根据内膜准备方案分为自然周期组(NC组,180个周期)和激素替代治疗周期组(HRT组,139个周期)。应用倾向性评分匹配法控制两组患者的混杂因素,经1∶1配对后共计纳入患者各106个周期。比较匹配前后两组的一般临床资料、FET周期临床资料以及妊娠结局,并采用多因素Logistic回归分析活产的影响因素。结果:(1)匹配前:HRT组的年龄小于NC组(P<0.05);HRT组的临床妊娠率、持续妊娠率、活产率均高于NC组(P<0.05)。匹配后:HRT组的临床妊娠率、持续妊娠率、活产率仍高于NC组(P<0.05)。(2)Logistic回归分析示:匹配前年龄(OR 0.934,P=0.020)和EMT(OR 1.254,P=0.036)是活产的独立影响因素;匹配后年龄(OR 0.879,P=0.002)和内膜准备方案(OR 2.504,P=0.004)是活产的独立影响因素;年龄分层后显示:在年龄小于35岁的TE患者中,内膜准备方案在匹配前后(OR 2.133;OR 3.054,P<0.05)均是活产的独立影响因素。结论:在FET周期中,TE患者采用HRT内膜准备方案能改善其临床妊娠结局。在年龄小于35岁的TE患者中,HRT内膜准备方案是活产的积极影响因素。Objective:To explore the effect of two endometrial preparation protocols on pregnancy outcome in patients with thin endometrium(TE)undergoing frozen thawed embryo transfer(FET).Methods:A retrospective case-control study design was used to analyze 319 cycles of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)in the Reproductive Center of Tianjin Central Obstetrics and Gynecology Hospital from January 2016 to May 2020,in which the endometrial thickness(EMT)was≤7 mm on the trigger day and the frozen-thawed embryo transfer was performed.The 319 cycles of frozen thawed embryo transfer(FET)were divided into natural cycle group(NC group,n=180)and hormone replacement cycle group(HRT group,n=139)according to the endometrial preparation protocol.The confounding factors of the two groups were controlled by propensity score matching(PSM).After 1∶1 paring,106 cycles were included in each group.The general clinical data,FET cycle clinical data and pregnancy outcome of the two groups were compared,and the influencing factors of live birth were analyzed by multivariate Logistic regression before and after PSM.Results:(1)Before PSM,the age of HRT group was younger than that of NC group(P<0.05).The clinical pregnancy rate,persistent pregnancy rate and live birth rate of HRT group were higher than those in NC group(P<0.05).After PSM,the clinical pregnancy rate,persistent pregnancy rate and live birth rate in HRT group were significantly higher than NC group(P<0.05).(2)Logistic regression analysis showed that age before matching(OR 0.934,P=0.020)and EMT(OR 1.254,P=0.036)were independent influencing factors of live birth.And age after matching(OR 0.879,P=0.002)and endometrial preparation protocol(OR 2.504,P=0.004)were independent influencing factors of live birth.The influencing factors of live birth were further analyzed by Logistic regression after age stratification.Among the patients with TE and younger than 35 years old,endometrial preparation protocol before and after matching was an independent influencing

关 键 词：薄型子宫内膜 冻融胚胎移植 激素替代周期 自然周期 

分 类 号：R714.8[医药卫生—妇产科学]