GnRH-a对PCOS全胚冷冻患者首次冻胚移植妊娠结局的影响  

Effects of GnRH-a on pregnancy outcomes of first frozen embryo transfer in PCOS patients with freeze-all cycles

作　　者：朱绍密 谭欣 李亨利 张曦熙 吕自力 Zhu Shaomi;Tan Xin;Li Hengli(School of Medical and Life Sciences/Reproductive & Women-Children Hospital,Chengdu University of Traditional Chinese Medicine,Chengdu 610041)

机构地区：[1]成都中医药大学医学与生命科学学院/附属生殖妇幼医院,成都610041

出　　处：《现代妇产科进展》2022年第7期499-503,共5页Progress in Obstetrics and Gynecology

基　　金：国家自然科学青年基金项目(No:82004176);四川省科技厅重大科技专项(No:2022YFS0251)。

摘　　要：目的:探讨多囊卵巢综合征(PCOS)全胚冷冻患者首次冻融胚胎移植(FET)激素替代内膜准备方案中,长效促性腺激素释放激素类似物(GnRH-a)对妊娠结局的影响。方法:回顾分析2017年6月至2021年1月于成都中医药大学医学与生命科学学院/附属生殖妇幼医院生殖医学中心辅助生殖技术助孕后全胚冷冻,且首次行FET的PCOS患者431例,按内膜准备方案分为GnRH-a降调节后激素替代(GnRH-a+HRT)组(211例),直接激素替代(HRT)组(220例)。对基础黄体生成素(LH)≥8U/L的102例患者进行亚组分析。从两个层面分析GnRH-a降调节在激素替代内膜准备方案中对患者妊娠结局的影响。结果:纳入病例总临床妊娠率为57.54%。患者的年龄、体质量指数(BMI)、不孕年限、获卵数、受精方式、平均移植胚胎数、移植胚胎类别、移植日内膜厚度比较,差异均无统计学意义(P>0.05)。GnRH-a+HRT组的基础LH水平、生化妊娠率、临床妊娠率、继续妊娠率、胚胎种植率高于HRT组,差异有统计学意义(P<0.05)。GnRH-a+HRT组的活产率高于HRT组,早期流产率低于HRT组,但差异无统计学意义(P>0.05)。结论:PCOS患者全胚冷冻后首次FET,GnRH-a降调节可增加内膜容受性,提高临床妊娠率,降低早期流产率,改善妊娠结局。Objective:To investigate the effect of long-acting gonadotropin-releasing hormone agonist(GnRH-a)on pregnancy outcomes in PCOS patients with whole embryo cryopreservation in the first frozen-thawed embryo transfer(FET)cycle with hormone replacement endometrial preparation protocol.Methods:431 PCOS patients who underwent FET for the first time after whole embryo freezing in School of Medical and Life Sciences/Reproductive&Women-Children Hospital,Chengdu University of Traditional Chinese Medicine were retrospectively analyzed between June 2017 and January 2021.According to the endometrial preparation protocol,the patients were divided into GnRH-a downregulated hormone replacement(GnRH-a+HRT)group(n=211)and hormone replacement(HRT)group(n=220).A subgroup analysis for 102 patients with basal luteinizing hormone(LH)≥8U/L was performed.The effects of GnRH-a in the HRT protocol on pregnancy outcomes were analyzed in two ways.Results:The clinical pregnancy rate of the included cases was 57.54%.No significant differences were detected in age,body mass index,years of infertility,number of oocytes retrieved,fertilization method,average number of transferred embryos,types of transferred embryos,and endometrial thickness on the day of transfer(P>0.05).The basal LH level,clinical pregnancy rate and ongoing pregnancy rate of GnRH-a+HRT group were higher than those of HRT group,and the difference was statistically significant(P<0.05).The GnRH-a+HRT group tended to show higher embryo implantation rate,live birth rate and lower early abortion rate than that of the HRT group,however,the difference was not statistically significant(P>0.05).Conclusion:In the first FET cycle with HRT protocol after whole embryo freezing in PCOS patients,GnRH-a could increase endometrial receptivity,improve clinical pregnancy rate,reduce early miscarriage rate,and improve pregnancy outcome.

关 键 词：多囊卵巢综合征 促性腺激素释放激素类似物 冻融胚胎移植 激素替代周期 

分 类 号：R711.75[医药卫生—妇产科学]