盆腔输卵管因素不孕且前次助孕失败患者再次冻融胚胎移植中应用GnRH-a的临床妊娠结局分析  

Pregnancy Outcome Analysis of GnRH-a Application in Patients with Pelvic and Fallopian Tube Factor Infertility in FET Cycles after Previous Pregnancy Failure

作　　者：郭春 冯桂梅 张潇潇[1] 吕群[1] 周敏[1] GUO Chun;FENG Guimei;ZHANG Xiaoxiao(Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Sichuan Provincial People′s Hospital,University of Electronic Science and Technology of China,Chengdu Sichuan 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院(电子科技大学附属医院)妇产科生殖中心,四川成都610072

出　　处：《实用妇产科杂志》2023年第10期763-768,共6页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金资助项目(编号:81801423);四川省自然科学基金项目(编号:2022NSFSC1499);四川省科技计划项目(编号:2022YFS0085)。

摘　　要：目的:探讨盆腔输卵管因素不孕患者助孕失败后,在冻融胚胎移植(FET)中使用促性腺激素释放激素激动剂(GnRH-a)对妊娠结局的影响。方法:回顾性分析2015年1月至2018年1月在四川省人民医院因盆腔输卵管因素不孕行FET且前次助孕失败的患者319例,根据FET周期中是否使用GnRH-a分为对照组(n=135)和GnRH-a组(n=184),比较两组患者一般临床资料和妊娠结局,并采用Logistic回归模型分析临床妊娠和自然流产的相关影响因素。同时按照子宫内膜厚度是否>8 mm和是否高龄(≥35岁)对患者进行再次分层,比较分层后患者一般临床资料和妊娠结局。结果:①单因素分析提示GnRH-a组子宫内膜更厚,临床妊娠率和自然流产率更高(P<0.05),但活产率差异无统计学意义(P>0.05)。Logistic回归分析提示:FET内膜准备方案中使用GnRH-a不是临床妊娠的独立影响因素(OR 1.428,P=0.142),是自然流产的独立影响因素(OR 2.499,P=0.024)。②分层分析发现,与对照组比较,子宫内膜厚度>8 mm且年龄<35岁患者中,GnRH-a组临床妊娠率(64.28%vs.50.00%,P<0.05)和自然流产率(30.86%vs.14.29%,P<0.05)更高。结论:对于盆腔输卵管因素不孕且有助孕失败史的患者,GnRH-a未提高患者的活产率,且自然流产率增加。Objective:To investigate the effect of GnRH-a on pregnancy outcomes of patients with pelvic or tubal factor infertility in frozen embryo transfer(FET)cycles after previous implantation failure.Methods:A retrospective analysis was performed on 319 infertility patients who underwent FET in Sichuan provincial people′s hospital from January 2015 to January 2018 due to pelvic or tubal factors and with a history of previous implantation failure,patients are divided into two groups based on whether GnRH-a was used in FET cycles,where there are 135 cases of hormone replacement cycle and 184 cases of GnRH-a combined hormone replacement cycle,and their baseline data and pregnancy outcomes were investigated.Moreover,Logistic regression model was used to analyze the relevant influencing factors of clinical pregnancy and spontaneous abortion.Then the patients were stratified again based on whether the endometrial thickness was thicker than 8mm and whether their age were equal or beyond 35 years old.Their baseline data and pregnancy outcomes were investigated after stratification.Results:①Univariate analysis suggested the endometrium in the GnRH-a group was thicker,the clinical pregnancy rate and spontaneous abortion rate were higher(P<0.05),while the difference in live birth rate was not statistically significant(P>0.05).Logistic regression analysis suggested that:The use of GnRH-a in the FET endometrial preparation protocol was not an independent influencing factor for clinical pregnancy(OR 1.428,P=0.142),but an independent influencing factor for spontaneous abortion(OR 2.499,P=0.024).②Stratified analysis showed higher clinical pregnancy rates(64.28%vs.50.00%,P<0.05)and higher spontaneous abortion rates(30.86%vs.14.29%,P<0.05)in GnRH-a group of patients with thicker than 8mm endometrium and under 35 years of age.Conclusions:In patients with pelvic or fallopian tube infertility and a history of implantation failure,the use of GnRH-a could not improve live birth rate,while spontaneous abortion rate was found increased.

关 键 词：促性腺激素释放激素激动剂 不孕 冻融胚胎移植 

分 类 号：R711.6[医药卫生—妇产科学]