| 引用本文： |
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焦雨帆,刘飞萍,傅夏燕,等.不同子宫内膜准备方案与冻融胚胎移植患者妊娠结局的相关性分析[J].同济大学学报（医学版）,2022,43(1):107-112. [点击复制]
- JIAO Yufan,LIU Feiping,FU Xiayan,et al.Effects of different endometrial preparation schemes on pregnancy outcome with frozen-thawed embryo transfer[J].同济大学学报（医学版）,2022,43(1):107-112. [点击复制]
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| 摘要: |
| 目的 比较不同子宫内膜准备方案对冻融胚胎移植（frozen-thawed embryo transfer, FET）患者临床妊娠率及活产率等临床结局的影响及其相关因素分析。方法 回顾性分析2016年7月1日—2018年12月31日在同济大学附属同济医院生殖医学中心进行的605个FET周期患者的临床资料及胚胎实验室数据。依据子宫内膜处理方案分为自然周期（natural cycle, NC）组、激素替代周期（hormone replacement cycle, HRT）组、促性腺激素释放激素激动剂联合激素替代周期（gonadotropin releasing hormone agonist plus hormone replacement cycle, GnRHa+HRT）组，比较3组周期患者的基本资料、子宫内膜厚度、子宫内膜容积、子宫动脉搏动指数(pulsatility index, PI)、阻力指数(resiteance index, RI)、收缩期与舒张期血流速度比值(peak systolic velocity/end-diastolic velocity, S/D)与妊娠结局的相关性。结果 3组患者年龄、不孕年限、体质量指数、冻胚级别差异无统计学意义（P＞0.05）；3种内膜准备方案的内膜转化日子宫内膜厚度、子宫内膜容积差异有统计学意义（P＜0.05），而子宫动脉PI、RI、S/D值均无明显差异；3组患者的早产率、早期自然流产率、晚期流产率、异位妊娠率、双胎妊娠率等妊娠结局，差异均无统计学意义（P＞0.05），而3组间足月产率的差异有统计学意义（P<0.05）；多因素Logistic回归分析表明，不同子宫内膜准备方案、单/双胎妊娠及不孕类型为患者足月产的独立影响因素，其中NC方案、单胎妊娠及原发不孕患者的足月产可能性更大（P＜0.05）。结论 NC周期行FET可获得较高的足月产率；经阴道超声测定子宫内膜容积及子宫动脉血流动力学参数可以反映子宫内膜容受性，可以指导FET胚胎移植时机的选择。对于薄型子宫内膜患者，给予HRT方案或GnRHa+HRT方案准备内膜，可获得更多移植机会。 |
| 关键词: 冻融胚胎移植 自然周期 激素替代周期 促性腺激素释放激素激动剂 妊娠结局 |
| DOI：10.12289/j.issn.1008-0392.21346 |
| 投稿时间：2021-08-13 |
| 基金项目:上海市同济医院临床研究项目（ITJ(QN)1813 2）；上海市卫生健康委员会项目（WSJ1915） |
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| Effects of different endometrial preparation schemes on pregnancy outcome with frozen-thawed embryo transfer |
| JIAO Yufan,LIU Feiping,FU Xiayan,CHEN Qizhen,JI Yazhong,WANG Yanqiu |
| (Reproductive Medical Center, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Shanghai Jiading District Maternal and Child Health Hospital, Shanghai 201821, China) |
| Abstract: |
| Objective To investigate the effects of different endometrial July 2016 to December 2018 preparation schemes on pregnancy outcome in patients undergoing frozen-thawed embryo transfer(FET). Methods The clinical and embryo laboratory data of 605 frozen-thawed embryo transfer cycles in the Reproductive Medicine Center of Tongji Hospital affiliated to Tongji University from were analyzed retrospectively. According to the endometrial treatment regimen, the patients were divided into three groups: natural cycle(NC) group(145 cycles), hormone replacement cycle(HRT) group(378 cycles) and gonadotropin releasing hormone agonist plus hormone replacement cycle group(GnRHa+HRT). The basic data, endometrial thickness, endometrial volume，uterine artery hemodynamic parameters and pregnancy outcome were compared among the three groups. Results There was no significant difference in age, infertility years, body mass index and frozen embryo grade among the three groups.There were significant differences in endometrial thickness and endometrial volume on the endometrial transformation day(P<0.05), while there was no significant difference in uterine artery PI, RI, and S/D values. There was no significant difference in preterm delivery, early spontaneous abortion, late abortion, ectopic pregnancy and twin pregnancy among the three groups(P>0.05), while there was significant difference in term delivery rate among the three groups(P<0.05). Multivariate Logistic regression analysis showed that endometrial preparation schemes, singleton/twin pregnancy and infertility types were independent influencing factors for pregnant outcomes. Endometrial preparation with NC regimen, singleton pregnancy and primary infertility can obtain higher term delivery rate, compared to other two schemes(P<0.05). Conclusion FET with NC cycle can obtain higher term delivery rate among the three endometrial preparation regimens. Transvaginal ultrasound measurement of endometrial volume and uterine artery hemodynamic parameters can reflect endometrial receptivity and guide the timing of FET embryo transfer. For patients with poor endometrial conditions, endometrial preparation with HRT or GnRHa+HRT regimens can get more chances of embryo transfer. |
| Key words: frozen-thawed embryo transfer natural cycle hormone replacement cycle gonadotropin-releasing hormone agonist pregnancy outcome |
