GnRH-a降调节在整倍体单囊胚解冻移植中的临床应用分析  

Clinical application of GnRH agonist down-regulation in frozen-thawed embryo transfer cycles with single euploid blastocysts

作　　者：贾博钦 蒋彦[1] 宋歌 朱玉林 吴小华 JIA Bo-qin;JIANG Yan;SONG Ge;ZHU Yu-lin;WU Xiao-hua(Shijiazhuang Obstetrics&Gynecology Hospital A f filiated to Hebei Medical University,Shijiazhuang 050011)

机构地区：[1]石家庄市妇产医院,石家庄050011

出　　处：《生殖医学杂志》2022年第6期788-793,共6页Journal of Reproductive Medicine

基　　金：石家庄市科学技术研究与发展计划(191201173)。

摘　　要：目的分析促性腺激素释放激素激动剂(GnRH-a)降调节联合激素替代对比单纯激素替代内膜准备方案对胚胎植入前遗传学检测(PGT)后整倍体单囊胚解冻移植妊娠结局的影响。方法回顾性分析2019年3月至2021年6月在本院生殖医学中心PGT检测后应用人工周期内膜准备方案的解冻移植周期103例,研究组为GnRH-a降调节联合激素替代组(共53周期),对照组为单纯激素替代组(共50周期),所有胚胎都经过二代测序技术,均为整倍体单囊胚移植。比较两组患者的基本情况及妊娠结局。结果两组患者女方平均年龄、体质量指数(BMI)、基础卵泡刺激素(FSH)、窦卵泡数、转化日子宫内膜厚度、转化日E2水平、转化日孕酮(P)水平及优质囊胚移植率比较,差异均无统计学意义(P>0.05);研究组的临床妊娠率、持续妊娠率和优质囊胚妊娠率均显著高于对照组(P<0.05);二元Logistic回归分析结果显示,在校正了以上患者的基本情况及是否优胚移植的因素后,GnRH-a降调节联合激素替代组相比于单纯激素替代组的临床妊娠率校正OR值为3.788,95%CI(1.522,9.431),持续妊娠率校正OR值为2.974,95%CI(1.232,7.180)。结论行PGT后整倍体单囊胚解冻移植时,GnRH-a降调节联合激素替代内膜准备方案能够获得比单纯激素替代内膜准备方案更高的临床妊娠率及持续妊娠率。Objective:To compare the effect of GnRH agonist(GnRH-a)down-regulation combined with hormone replacement on the pregnancy outcome of single frozen-thawed euploid blastocyst transfer after preimplantation genetic test(PGT)with simple hormone replacement endometrial preparation protocol.Methods:The data of 103 frozen-thawed transfer cycles with artificial endometrial preparation protocol after PGT test in the reproductive medicine center of our hospital from March 2019 to June 2021 were analyzed retrospectively.The study group included 53 cycles with GnRH-a down-regulation combined with artificial endometrial preparation protocol,and the control group included 50 cycles with simple hormone replacement endometrial preparation protocol.All embryos underwent second-generation sequencing screen,and the single euploid blastocyst was transferred.The basic condition and pregnancy outcome of the two groups were compared.Results:There were no significant differences in female average age,body mass index(BMI),basic FSH,number of antral follicles,endometrial thickness,estradiol and progesterone levels on the transformation day,and high-quality blastocyst transfer rate between the two groups(P>0.05).The clinical pregnancy rate,ongoing pregnancy rate and good-quality blastocyst pregnancy rate in study group were significantly higher than those in the control group(P<0.05).The results of binary logistic regression analysis showed that after adjusting the basic conditions and whether the blastocyst transferred was good-quality,the odds ratio(OR)of clinical pregnancy rate in GnRH agonist down-regulation combined with simple hormone replacement group was 3.788,95%CI(1.522,9.431),and the OR value of ongoing pregnancy rate was 2.974,95%CI(1.232,7.180).Conclusions:When single frozen-thawed euploid blastocyst after PGT is transplanted,the GnRH agonist combined hormone replacement endometrial preparation protocol can achieve a higher clinical pregnancy rate and ongoing pregnancy rate compared with the simple hormone replacement endometr

关 键 词：胚胎植入前遗传学检测 GnRH-a预处理 冻融胚胎移植 临床妊娠率 持续妊娠率 

分 类 号：R711.6[医药卫生—妇产科学] R321.3[医药卫生—临床医学]