不同内膜准备方案对冻融单囊胚移植流产率的影响  

Impact of endometrial preparation protocols on pregnancy losses in single frozen-thawed blastocyst transfer cycles

作　　者：苗菁菁 师娟子 薛侠 蔡贺 MIAO Jing-jing;SHI Juan-zi;XUE Xia;CAI He(Xi’an Medical University,Xi’an 710021;Department of Reproductive Medicine,Northwest Women’s and Children’s Hospital,Xi’an 710000)

机构地区：[1]西安医学院,西安710021 [2]西北妇女儿童医院生殖中心,西安710000

出　　处：《生殖医学杂志》2022年第8期1093-1098,共6页Journal of Reproductive Medicine

摘　　要：目的比较人工周期和自然周期内膜准备方案对冻融单囊胚移植(FBT)自然流产率(包括生化妊娠率及临床流产率)的影响。方法回顾性分析2015年1月至2020年12月在西北妇女儿童医院生殖中心接受FBT、血清HCG≥10 U/L的3099个周期的临床资料,根据内膜准备方案分为人工周期组(AC组,2615个周期)和自然周期组(NC组,484个周期)。比较两组患者的一般资料和妊娠结局,并通过广义估计方程(GEE)对年龄、既往妊娠史和囊胚形态等进行多因素回归分析,比较两种内膜准备方案与生化妊娠率及临床流产率的关系。结果AC组患者的平均年龄显著低于NC组(P<0.01)。AC组内细胞团(ICM)评级为A、B级的周期比例显著高于NC组(P<0.05),而评级C级的周期比例显著低于NC组(P<0.05);NC组滋养外胚层(TE)评级为A、B级的周期比例均显著少于AC组(P<0.01),而评级C级的周期比例显著多于AC组(P<0.01)。AC组患者的生化妊娠率、临床流产率略高于NC组,但尚无显著性差异(P>0.05);活产率则显著低于NC组(P<0.05)。GEE多因素回归模型中,两组生化妊娠率无显著性差异[aOR=1.43,95%CI(0.96,2.12),P=0.08],AC组临床流产率显著高于NC组[aOR=1.42,95%CI(1.08,1.87),P=0.01]。FBT的生化妊娠率和囊胚ICM分级相关,ICM评级C级的生化妊娠风险显著高于ICM评级A级[aOR=2.31,95%CI(1.26,4.22),P=0.01];年龄则显著影响临床流产率,高龄女性的临床流产率显著增加[aOR=1.06,95%CI(1.04,1.69),P<0.01]。结论人工周期内膜准备方案不增加FBT周期的生化妊娠率,但可能与临床流产率升高相关。Objective:To compare the effects of artificial cycle and natural cycle endometrial preparation protocols on the spontaneous abortion rate(including biochemical pregnancy rate and clinical abortion rate)of single frozen-thawed blastocyst transfer(FBT).Methods:The clinical data of 3099 FBT cycles with serum HCG≥10 U/L conducted in the reproductive center of Northwest Women’s and Children’s Hospital from January 2015 to December 2020 were retrospectively analyzed.They were divided into artificial cycle group(AC group,n=2615)and natural cycle group(NC group,n=484)according to the endometrial preparation protocol.The general data and pregnancy outcomes of the two groups were compared.The age,previous pregnancy history and blastocyst morphology were analyzed by multivariate regression analysis using generalized estimating equation(GEE).The relationship between the endometrial preparation protocol and biochemical pregnancy rate and clinical abortion rate was compared.Results:The mean age of patients in AC group was significantly lower than that in NC group(P<0.01).The percentage of cycles with grade A and B of inner cell mass(ICM)in AC group was significantly higher than that in NC group(P<0.05),while the percentage of cycles with grade C of ICM was significantly lower than that in NC group(P<0.05).The proportion of cycles with grade A and B of trophoblastic ectoderm(TE)in AC group was significantly higher than that of NC group(P<0.01),while the proportion of cycles with grade C of TE was significantly lower than that of NC group(P<0.01).The biochemical pregnancy rate and clinical abortion rate in AC group were slightly higher than those in NC group,but the difference was not significant(P>0.05),while the live birth rate was significantly lower than that in NC group(P<0.05).In GEE multivariate regression model,there was no significant difference in biochemical pregnancy rate between the two groups[aOR=1.43,95%CI(0.96,2.12),P=0.08].The clinical abortion rate in AC group was significantly higher than that in NC grou

关 键 词：自然流产率 生化妊娠率 冻融囊胚移植 内膜准备方案 

分 类 号：R711.6[医药卫生—妇产科学]