冻融胚胎移植周期中不同内膜准备方案对不明原因反复种植失败患者妊娠结局的影响  

Effect of different endometrial preparation protocols on pregnancy outcome of frozen-thawed embryo transfer in patients with unexplained repeated implantation failure

作　　者：段霞 王治鸿[2] 杨园 梁慧枝 康宜凡 高青卓 尹朝芳 DUAN Xia;WANG Zhi-hong;YANG Yuan;LIANG Hui-zhi;KANG Yi-fan;GAO Qing-zhuo;YIN Chao-fang(Shanxi Medical University,Taiyuan 030001;Shanxi Medical University First Hospital Reproductive Center,Taiyuan 030001;Shanxi Provincial Maternal&Child Health Hospital,Taiyuan 030001)

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第一医院生殖中心,太原030001 [3]山西省儿童妇幼保健院,太原030001

出　　处：《生殖医学杂志》2023年第7期1021-1029,共9页Journal of Reproductive Medicine

摘　　要：目的探讨在冻融胚胎移植(FET)中不同内膜准备方案对不明原因反复种植失败(RIF)患者妊娠结局的影响。方法回顾性分析2019年6月至2021年6月在山西医科大学第一医院生殖中心助孕的不明原因RIF患者的643个FET周期的临床资料。根据内膜准备方案不同分为4组:自然周期组(NC组,n=180)、激素替代周期组(HRT组,n=273)、GnRH-a垂体降调节+激素替代周期组(GnRH-a+HRT组,n=105)以及促排卵周期组(OI组,n=85),分析4组患者的一般资料、胚胎移植情况以及妊娠结局。结果4组患者间取卵和胚胎移植年龄、不孕时间及不孕类型、体质量指数(BMI)、基础性激素水平等一般资料比较均无统计学差异(P>0.05)。4组患者间移植胚胎数、移植胚胎类型、移植日孕酮水平比较均无统计学差异(P>0.05);NC组移植日雌二醇水平显著低于其他3组(P<0.05);GnRH-a+HRT组移植日子宫内膜厚度、临床妊娠率、胚胎种植率显著高于其他3组(P<0.05),而生化妊娠率显著低于HRT组(P<0.05);4组间流产率、异位妊娠率、多胎妊娠率、活产率比较均无统计学差异(P>0.05)。对临床妊娠结局进行多因素回归分析显示,使用GnRH-a+HRT方案准备内膜对不明原因RIF患者FET妊娠结局具有保护作用(P<0.05),移植日子宫内膜厚度对妊娠结局也呈一定程度的正向影响(P<0.05)。结论在FET周期中,与自然周期、激素替代周期以及促排卵周期方案相比,采用GnRH-a垂体降调节+激素替代周期方案准备内膜可以更好地改善不明原因RIF患者的妊娠结局。Objective:To investigate the effect of different endometrial preparation protocols on the pregnancy outcome of frozen-thawed embryo transfer(FET)in the patients with unexplained repeated implantation failure(RIF).Methods:The clinical data of 643 FET cycle in patients diagnosed with unexplained RIF at the Reproductive Medicine Center of the First Hospital of Shanxi Medical University from June 2019 to June 2021 were retrospectively analyzed.According to the different endometrial preparation protocols,the patients were divided into four groups:natural cycle group(NC group,n=180),hormone replacement cycle group(HRT group,n=273),GnRH agonist(GnRH-a)pituitary down-regulation+hormone replacement cycle group(GnRH-a+HRT group,n=105)and ovulation induction cycle group(OI group,n=85).The general data,embryo transfer and pregnancy outcomes of the four groups were analyzed.Results:There were no significant differences in the age at oocyte retrieval and embryo transfer,infertility time and type,body mass index(BMI),basic sex hormone levels among the four groups(P>0.05).There were no significant differences in number and type of the embryos transferred,progesterone levels on the embryo transfer day(P>0.05).The estradiol levels on the day of embryo transfer in the NC group were significantly lower than those in the other three groups(P<0.05).The endometrial thickness,clinical pregnancy rate and embryo implantation rate in GnRH-a+HRT group were significantly higher than those in other three groups(P<0.05),while the biochemical pregnancy rate was significantly lower than that in HRT group(P<0.05).There were no significant differences in abortion rate,ectopic pregnancy rate,multiple pregnancy rate and live birth rate among the four groups(P>0.05).Multivariate regression analysis of clinical pregnancy showed that the use of GnRH-a+HRT protocol to prepare the endometrium had a protective effect on pregnancy outcome of unexplained RIF patients(P<0.05),and the endometrial thickness on the day of embryo transfer was also positively cor

关 键 词：反复种植失败 冻融胚胎移植 子宫内膜准备 降调节激素替代周期 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]