降调节激素替代周期对既往子宫内膜异常患者FET临床结局的影响  

Effect of down-regulated hormone replacement cycle on pregnancy outcome of FET in patients with previous endometrial abnormalities

作　　者：李仪[1] 高红 颜晓红[1] 张志明[2] 李友筑[1,3] LI Yi;GAO Hong;YAN Xiao-hong;ZHANG Zhi-ming;LI You-zhu(Reproductive Center,the First Affiliated Hospital of Xiamen University,Xiamen 361000;Breast Surgery,the First Affiliated Hospital of Xiamen University,Xiamen 361000;Xiamen Assisted Reproductive Technology Quality Control Center,Xiamen 361013)

机构地区：[1]厦门大学附属第一医院生殖医学科,厦门361000 [2]厦门大学附属第一医院乳腺外科,厦门361000 [3]厦门市辅助生殖技术质控中心,厦门361013

出　　处：《生殖医学杂志》2022年第12期1627-1632,共6页Journal of Reproductive Medicine

基　　金：福建省卫生教育联合攻关计划项目(2019-WJ-34)。

摘　　要：目的探讨降调节激素替代周期(GnRH-a+HRT)方案对既往子宫内膜异常患者冻融胚胎移植(FET)临床结局的影响。方法回顾性分析2019年10月至2021年11月在厦门大学附属第一医院因子宫内膜异常而行FET的患者的临床资料。根据内膜准备方案的不同,将纳入的393个周期分为2组,降调节激素替代周期组(GnRH-a+HRT组,n=332)和人工周期组(HRT组,n=61);再以患者既往是否有流产手术史进行亚组分析,其中GnRH-a+HRT组又分为流产史组(n=65)和无流产史组(n=267),HRT组分为流产史组(n=20)和无流产史组(n=41)。比较两种FET内膜准备方案的临床妊娠结局以及亚组间的结局差异。结果整体比较中,两组患者的基本资料及移植情况均无显著性差异(P>0.05);与HRT组相比,GnRH-a+HRT组的胚胎种植率(40.43%vs.26.09%)及临床妊娠率(51.81%vs.36.07%)均显著升高(P<0.05),而生化妊娠率、活产率和流产率虽有改善趋势,但差异均无统计学意义(P>0.05)。亚组分析结果显示,GnRH-a+HRT组的无流产史患者的临床妊娠率(52.43%vs.49.23%)显著高于有流产史患者(P<0.05);HRT组中有无流产史患者间的妊娠结局指标均无显著性差异(P>0.05)。结论既往有子宫内膜异常病史的患者在FET周期中采用降调节方案能获得更高的胚胎种植率及临床妊娠率,且无流产史的患者能获得更好的妊娠结局。Objective:To explore the effect of GnRH agonist down-regulation plus hormone replacement cycle(GnRH-a+HRT)protocol on the clinical outcome of frozen-thawed embryo transfer(FET)in patients with previous endometrial abnormalities.Methods:The clinical data of the patients with previous endometrial abnormalities who underwent FET treatment in the First Affiliated Hospital of Xiamen University from October 2019 to November 2021 were retrospectively analyzed.According to the different endometrial preparation protocols,393 cycles of the patients were divided into two groups:the down-regulation hormone replacement cycle group(GnRH-a+HRT group,n=332)and the artificial cycle group(HRT group,n=61).Then subgroup analysis was conducted based on whether the patients had previous abortion surgery history.GnRH-a+HRT group was further divided into abortion history group(n=65)and no abortion history group(n=267),and HRT group was divided into abortion history group(n=20)and no abortion history group(n=41).The clinical pregnancy outcomes were compared between the two FET endometrial preparation protocols and among the subgroups.Results:In the overall comparison,there was no significant difference in the basic information and transplantation status between the two groups(P>0.05).Compared with the HRT group,the embryo implantation rate(40.43%vs.26.09%)and clinical pregnancy rate(51.81%vs.36.07%)in the GnRH-a+HRT group were significantly increased(P<0.05),while the biochemical pregnancy rate,live birth rate and abortion rate had a trend of improvement,but there was no significant difference(P>0.05).Subgroup analysis showed that the clinical pregnancy rate(52.43%vs.49.23%)of patients without abortion history in GnRH-a+HRT group was significantly higher than that of patients with abortion history(P<0.05).There was no significant difference in clinical pregnancy indexes between patients with or without abortion history in HRT group(P>0.05).Conclusions:For the patients with a history of endometrial abnormalities,the down-regulation protoc

关 键 词：降调节激素替代周期 冻融胚胎移植 子宫内膜异常 

分 类 号：R711.6[医药卫生—妇产科学]