3种子宫内膜准备方案对冻融胚胎移植患者妊娠结局的影响

doi:10.13481/j.1671-587x.20190225

吉林大学学报(医学版) ›› 2019, Vol. 45 ›› Issue (02): 359-363.doi: 10.13481/j.1671-587x.20190225

• 临床研究 • 上一篇

3种子宫内膜准备方案对冻融胚胎移植患者妊娠结局的影响

侯全灵¹, 陈思瑶¹, 薛百功², 王靖莹¹, 谢娱新¹, 杨超¹, 周鹤¹, 房书珈¹, 路英丽¹

1. 吉林大学第二医院妇产科生殖中心, 吉林长春 130041;
2. 吉林大学基础医学院细胞生物学教研室, 吉林长春 130021

收稿日期:2018-12-18 发布日期:2019-03-29
通讯作者: 路英丽,副教授,主任医师,硕士研究生导师(Tel:0431-81136331,E-mail:luyl@jlu.edu.cn) E-mail:luyl@jlu.edu.cn
作者简介:侯全灵(1992-),女,山东省济宁市人,在读医学硕士,主要从事妇产科辅助生殖方面的研究。
基金资助:
国家自然科学基金青年科学基金资助课题（81501221）；吉林省财政厅卫生专项项目资助课题（201715602365）

Effects of three kinds of endometrial preparation on pregnancy outcomes of patientswith frozen-thawed embryo transfer

HOU Quanling¹, CHEN Siyao¹, XUE Baigong², WANG Jingying¹, XIE Yuxin¹, YANG Chao¹, ZHOU He¹, FANG Shujia¹, LU Yingli¹

1. Reproductive Center, Department of Obstetrics and Gynecology, Second Hospital, Jilin University, Changchun 130041, China;
2. Department of Cell Biology, School of Basic Medical Sciences, Jilin University, Changchun 130021, China

Received:2018-12-18 Published:2019-03-29

摘要/Abstract

摘要： 目的：探讨在子宫内膜异位症（EMT）、子宫腺肌症或不明原因反复种植失败（RIF）患者冻融胚胎移植（FET）周期中，单纯激素替代方案、半量长效促性腺激素释放激素激动剂（GnRH-a）和全量长效GnRH-a降调节后联合激素替代方案3种内膜准备方法对移植后妊娠结局的影响，为临床内膜准备方案的选择提供依据。方法：选择进行FET治疗的EMT、子宫腺肌症或不明原因RIF患者191例，按照子宫内膜准备方法分为单纯激素替代组（n=63）、半量GnRH-a组（n=61）和全量GnRH-a组（n=67）。回顾性分析并比较各组患者年龄、体质量指数（BMI）、不孕年限、移植周期数、移植胚胎数、孕激素转化日内膜厚度、移植日内膜厚度、移植优质胚胎率、宫内临床妊娠率和胚胎种植率等情况。结果：3组FET周期患者的一般临床资料，包括年龄、BMI、不孕年限、移植周期数、移植胚胎数、孕激素转化日内膜厚度、移植日内膜厚度和移植优质胚胎率比较差异均无统计学意义（P>0.05）；全量GnRH-a组和半量GnRH-a组患者宫内临床妊娠率及胚胎种植率明显高于单纯激素替代组（χ²=9.000，P<0.05；χ²=7.917，P<0.05）；与半量GnRH-a组比较，全量GnRH-a组宫内临床妊娠率和胚胎种植率比较差异均无统计学意义（P>0.05）。结论：在EMT、子宫腺肌症或不明原因RIF患者FET周期中，GnRH-a降调节后联合激素替代方案可有效改善FET妊娠结局；全量长效GnRH-a及半量长效GnRH-a降调节后的妊娠结局较为相似，并且半量长效GnRH-a更有利于减轻患者的经济负担，可作为FET周期中内膜准备方案的理想选择。

关键词: 冻融胚胎移植, 内膜准备方案, 促性腺激素释放激素激动剂, 降调节, 妊娠结局

Abstract: Objective: To investigate the effects of three kinds of endometrial preparation (normal hormone replacement,half- and full-dose of long-acting gonadotropin-releasing hormone agonist (GnRH-a) down-regulation combined with hormone replacement) on the pregnancy outcomes in the frozen-thawed embryo transfer (FET) cycle in the patients with endometriosis(EMT),adenomyosis or repeated implantation failure (RIF)for unknown reasons, and to provide a basis for the selection of clinical endometrial preparation method.Methods: A total of 191 patients with EMT,adenomyosis or RIF for unknown reasons underwent FET treatment were selected.The patients were divided into normal hormone replacement group(n=63),half-dose GnRH-a group(n=61) and full-dose GnRH-a group(n=67) according to the endometrial preparation method.The clinical data of patients in each group such as age,body mass index(BMI),duration of infertility,the number of embryo transfer cycles,the number of embryos transferred,the endometrial thickness on the day of conversion and transplantation,the rate of high-quality embryos transferred,the intrauterine clinical pregnancy rate and the embryo implantation rate were analyzed retrospectively and compared.Results: There were no significant differences of the general clinical data of the patients in FET cycles in three groups such as age,BMI,duration of infertility,the number of embryo transfer cycles,the number of embryos transferred,the endometrial thickness on the day of conversion and transplantation,and the rate of high-quality embryos transferred(P>0.05);the intrauterine clinical pregnancy rate and the embryo implantation rate of the patients in full-dose GnRH-a group and half-dose GnRH-a group were significantly higher than those of the patients in normal hormone replacement group(χ² = 9.000,χ² =7.917, P<0.05), but there were no statistically significant differences between half-dose GnRH-a group and full-dose GnRH-a group (P>0.05).Conclusion: In the FET cycles of the patients with EMT, adenomyosis or RIF for unknown reasons, hormone replacement after down-regulation of GnRH-a can effectively improve the pregnancy outcome of FET.The pregnancy outcomes of full-dose and half-dose of long-acting GnRH-a are relatively similar, and half-dose long-acting GnRH-a is more conducive to reduce the financial burden of the patients,and it is a ideal choice for endometrium preparation protocol in FET cycle.

Key words: frozen-thawed embryo transfer, endometrium preparation protocol, gonadotropin releasing hormone agonist, down-regulation, pregnancy outcome

中图分类号:

R711.6

侯全灵, 陈思瑶, 薛百功, 王靖莹, 谢娱新, 杨超, 周鹤, 房书珈, 路英丽. 3种子宫内膜准备方案对冻融胚胎移植患者妊娠结局的影响[J]. 吉林大学学报(医学版), 2019, 45(02): 359-363.

HOU Quanling, CHEN Siyao, XUE Baigong, WANG Jingying, XIE Yuxin, YANG Chao, ZHOU He, FANG Shujia, LU Yingli. Effects of three kinds of endometrial preparation on pregnancy outcomes of patientswith frozen-thawed embryo transfer[J]. Journal of Jilin University(Medicine Edition), 2019, 45(02): 359-363.

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3种子宫内膜准备方案对冻融胚胎移植患者妊娠结局的影响

Effects of three kinds of endometrial preparation on pregnancy outcomes of patientswith frozen-thawed embryo transfer

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