激素替代冻融单囊胚移植周期中孕酮转化子宫内膜时间对妊娠结局的影响  

Effects of endometrial progesterone preparation time on pregnancy outcome in hormone replacement and single frozen-thawed blastocyst transfer cycle

作　　者：李秀芳 李元美 王忠清 朱蕾 王慧丹 盛燕 连方[5] LI Xiu-fang;LI Yuan-mei;WANG Zhong-qing;ZHU Lei;WANG Hui-dan;SHENG Yan;LIAN Fang(The First Clinical College,Shandong University of Traditional Chinese Medicine,Jinan 250014;Medical College of Optometry and Ophthalmolgy,Shandong University of Traditional Chinese Medicine,Jinan 250014;Reproductive Hospital Affiliated to Shandong University,Jinan 250021;Jinan Golden Time Health Nursing Hospital,Jinan 250000;Reproductive and Genetic Center of Integtated Traditional and Western Medicine,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan250011)

机构地区：[1]山东中医药大学第一临床医学院,济南250014 [2]山东中医药大学眼科与视光医学院,济南250014 [3]山东大学附属生殖医院,济南250021 [4]济南金龄健康护理院,济南250000 [5]山东中医药大学附属医院中西医结合生殖与遗传中心,济南250011

出　　处：《生殖医学杂志》2023年第3期357-363,共7页Journal of Reproductive Medicine

基　　金：国家自然科学基金(82174429);罗元恺滋肾育胎丸中青年科研基金(20190810)。

摘　　要：目的探讨在激素替代冻融单囊胚移植周期中,孕酮转化子宫内膜时间对妊娠结局的影响。方法回顾性分析2017年1月至2021年10月于山东大学附属生殖医院行激素替代周期准备子宫内膜行冻融单囊胚移植的2131个周期的临床资料。根据移植前孕酮转化子宫内膜时间的不同分为2组:A组在孕酮转化子宫内膜5 d后行冻融胚胎移植(FET)(n=1420),B组在孕酮转化子宫内膜6 d后行FET(n=711)。比较两组患者的基础资料及临床妊娠结局,并根据移植的囊胚发育天数的不同进行亚组分析。结果两组患者基础资料比较无显著性差异(P>0.05)。除B组的早期流产率显著高于A组(17.6%vs.12.4%,P<0.05)外,两组间的临床妊娠率、胚胎种植率、异位妊娠率、中晚期流产率、妊娠期并发症发生率、活产率以及新生儿出生体重差异均无统计学意义(P均>0.05)。在亚组分析中,移植D5囊胚A、B两组和移植D6囊胚A、B两组间的临床妊娠结局均无显著性差异(P均>0.05);A组患者中移植D5优质囊胚的临床妊娠率(62.9%vs.52.8%)及活产率(52.7%vs.41.8%)均高于移植D6囊胚患者;B组患者中移植D5优质囊胚的临床妊娠率(61.1%vs.47.6%)及活产率(49.7%vs.33.7%)也均高于移植D6囊胚患者(P<0.05)。结论激素替代周期冻融单囊胚移植中,孕酮转化子宫内膜5 d后移植D5优质囊胚,可以降低早期流产率,获得满意的临床结局。Objective:To explored the effects of endometrial progesterone preparation time on pregnancy outcomes in hormone replacement&single frozen-thawed blastocyst transfer cycles.Methods:The clinical data of 2131 frozen-thawed embryo transfer cycles with hormone replacement endometrial preparation in Reproductive Hospital Affiliated to Shandong University from January 2017 to October 2021 were retrospectively analyzed.The cycles were divided into two groups according to the endometrial progesterone preparation time:group A(FET at 5 days after progesterone administration,n=1420)and group B(FET at 6 days after progesterone administration,n=711).The general data and pregnancy outcomes were compared between the two groups.And subgroup analysis was performed according to the development days of blastocyst.Results:There was no significant difference in general data between the two groups(P>0.05).There were no significant differences in clinical pregnancy rate,embryo implantation rate,ectopic pregnancy rate,intermediate and late abortion rate,live birth rate,and birth weight between the two groups(all P>0.05),but the early abortion rate in group B was significantly higher than that in group A(17.6%vs.12.4%,P<0.05).In subgroup analysis,there was no significant difference in clinical pregnancy outcomes between group A and group B or between groups A and B with Day 6 blastocyst transplantation(all P>0.05).In group A,the clinical pregnancy rate(62.9%vs.52.8%)and live birth rate(52.7%vs.41.8%)of Day 5 blastocysts transplantation were significantly higher than those of Day 6 blastocysts transplantation.In group B,the clinical pregnancy rate(61.1%vs.47.6%)and live birth rate(49.7%vs.33.7%)of Day 5 blastocysts were also significantly higher than those of Day 6 blastocysts(P<0.05).Conclusions:In HRT-FET cycles,transplantation of Day 5 high-quality blastocyst at 5 days after endometrial progesterone preparation can reduce the early abortion rate and obtain satisfactory clinical outcomes.

关 键 词：冻融胚胎移植 激素替代 妊娠结局 孕酮 单囊胚移植 

分 类 号：R711.6[医药卫生—妇产科学]