降调节+激素替代周期内膜准备方案在高龄女性冻融胚胎移植中的应用结局  

The outcome of down-regulation+hormone replacement cycle endometrial preparation regimen in frozen-thawed embryo transfer in advanced age women

作　　者：王晓燕[1] 杨晨曦[1] 赵燕[1] 阿艳妮 WANG Xiaoyan;YANG Chenxi;ZHAO Yan;A Yanni(Reproductive Medicine Center,Women and Children’s Hospital Affiliated to Qingdao University,Qingdao,Shandong 266011,China;Department of Gynecology,Women and Children’s Hospital Affiliated to Qingdao University,Qingdao,Shandong 266011,China)

机构地区：[1]青岛大学附属妇女儿童医院生殖医学中心,山东青岛266011 [2]青岛大学附属妇女儿童医院妇科,山东青岛266011

出　　处：《重庆医学》2024年第2期251-256,共6页Chongqing medicine

基　　金：山东省妇幼保健科学技术项目(SFYXH-2023W025)。

摘　　要：目的分析降调节+激素替代周期(HRT)内膜准备方案对高龄(≥35岁)女性行冻胚移植妊娠结局的影响。方法回顾性分析2020年6月至2022年6月在该院行冻胚移植的329例患者临床资料,其中149例采用促性腺激素释放激素激动剂(GnRHa)降调节+HRT准备内膜者纳入A组,其余180例采用HRT准备内膜者纳入B组,比较两组基础情况、内膜转化日情况及临床结局。进一步按年龄将A、B组分别分为两个亚组:A1组(35~<40岁,n=101)、A2组(≥40岁,n=48)、B1组(35~<40岁,n=99)、B2组(≥40岁者,n=81),比较不同年龄段两种内膜准备方案的效果。结果两组年龄、不孕年限、BMI、抗苗勒氏管激素水平,以及雌二醇、孕酮、卵泡刺激素、黄体生成素(LH)、泌乳素和睾酮等基础激素水平均无明显差异(P>0.05)。A组转化日雌二醇、LH水平均明显低于B组(P<0.05),内膜厚度、转化日内膜厚度≥8 mm患者比例、Ⅲ型血流内膜患者比例均明显高于B组(P<0.05);两组移植胚胎数、移植优胚数无明显差异(P>0.05)。A组临床妊娠率(46.31%vs.35.56%)及临床种植率(33.33%vs.25.18%)均明显高于B组(P<0.05),两组早期流产率无明显差异(P>0.05);进一步亚组分析显示:A2组临床妊娠率(35.42%vs.18.52%)及临床种植率(21.43%vs.12.40%)均明显高于B2组(P<0.05),而A1组与B1组无明显差异(P>0.05)。结论高龄患者行冻融胚胎移植可选择GnRHa降调节+HRT方案以获得更好的妊娠结局,且尤其适用于≥40岁者。Objective To analyze the effects of down-regulation+hormone replacement therapy(HRT)endometrial preparation regimen on the pregnancy outcomes of advanced age women(≥35 years old)undergoing frozen-thawed embryo transfer.Methods The clinical data of 329 patients with frozen-thawed embryo transfer in this hospital from June 2020 to June 2022 were analyzed retrospectively.Among them,149 patients receiving gonadotropin-releasing hormone analogue(GnRHa)down-regulation+HRT endometrial preparation were included in the group A,and the other 180 patients with HRT endometrial preparation were included in the group B.The basic situation,endometrial transformation day situation and clinical outcome were compared between the two groups.The group A and group B were further divided into the two subgroups according to age:group A1(35-<40 years old,n=101),group A2(≥40 years old,n=48),group B1(35-<40 years old,n=99)and group B2(≥40 years old,n=81).The effects of two endometrial preparation regimens were compared among the different age groups.Results There were no significant differences in the age,infertility years,BMI,anti-Müllerian hormone level,as well as basal hormones levels such as estradiol,progesterone,follicle-stimulating hormone,luteinizing hormone(LH),prolactin and testosterone between the two groups(P>0.05).The levels of estradiol and LH on the endometrial transformation day in the group A were significantly lower than those in the group B(P<0.05),the endometrial thickness,proportion of the patients with endometrial thickness≥8 mm and proportion of the patients with typeⅢblood intima in the group A were significantly higher than those in the group B(P<0.05).There was no significant difference in the number of transplanted embryos and the number of transplanted excellent embryos between the two groups(P>0.05).The clinical pregnancy rate and embryo implantation rate in the group A were significantly higher than those in the group B(46.31%vs.35.56%;33.33%vs.25.18%,P<0.05),and there was no significant difference

关 键 词：垂体降调节 冻胚移植 激素替代周期 子宫内膜准备 高龄妇女 

分 类 号：R714.8[医药卫生—妇产科学]