人绒毛膜促性腺激素对降调节人工周期冻融胚胎移植临床结局的影响

目的探讨人绒毛膜促性腺激素(HCG)对降调节人工周期冻融胚胎移植(FET)临床结局的影响。方法回顾性分析2018年6月至2021年4月于我院生殖中心行垂体降调节人工周期FET共196个周期的临床资料。根据内膜转化前是否使用HCG分组,肌肉注射HCG的患者为HCG组(n=88),未注射HCG的患者为对照组(n=108),比较两组患者的一般资料和妊娠结局;采用单因素/多因素Logistic回归模型分析FET患者临床妊娠率的影响因素。结果两组间一般资料比较均无显著性差异(P>0.05)。HCG组的平均移植胚胎数显著低于对照组[(1.40±0.49)vs.(1.56±0.52)](P<0.05),而临床妊娠率(65.91%vs.51.85%)和胚胎种植率(54.47%vs.40.47%)均显著高于对照组(P<0.05);两组间HCG阳性率、异位妊娠率和早期流产率比较均无显著性差异(P>0.05)。单因素Logistic回归分析结果显示,内异症[OR=0.505,95%CI(0.258,0.988),P=0.046]和使用HCG[OR=1.795,95%CI(1.005,3.207),P=0.048]会影响FET临床妊娠率;多因素Logistic回归分析结果显示,调整混杂因素后,使用HCG仍是FET临床妊娠率的影响因素[OR=2.266,95%CI(1.069,4.804),P=0.033]。结论降调节人工周期FET内膜转化前肌肉注射HCG有助于提高胚胎种植率和临床妊娠率。

Effect of HCG on clinical outcome of frozen-thawed embryo transfer cycle with pituitary down-regulation hormone replacement protocol

Objective:To investigate the effect of HCG on the clinical outcome of frozen-thawed embryo transfer(FET)cycles with pituitary down-regulation hormone replacement protocol.Methods:The clinical data of 196 FET cycles with pituitary down-regulation hormone replacement protocol in the center of reproductive medicine of our hospital from June 2018 to April 2021 were retrospectively analyzed.According to whether HCG was used before endometrial transformation,the patients were divided into two groups:the patients who received HCG intramuscular injection were in HCG group(n=88),and the patients who did not used HCG were in the control group(n=108).The general data and pregnancy outcomes were compared between the two groups.Univariate/multivariate logistic regression model was used to analyze the influencing factors of clinical pregnancy rate in patients with FET.Results:There was no significant difference in general data between the two groups(P>0.05).The average number of embryos transfer in the HCG group was significantly less than that in the control group[(1.40±0.49)vs.(1.56±0.52),P<0.05],while the clinical pregnancy rate(65.91%vs.51.85%)and embryo implantation rate(54.47%vs.40.47%)were significantly higher than those in the control group(P<0.05).There were no significant differences in HCG positive rate,ectopic pregnancy rate and early miscarriage rate between the two groups(P>0.05).Univariate logistics regression analysis showed endometriosis[OR=0.505,95%CI(0.258,0.988),P=0.046]and usage of HCG[OR=1.795,95%CI(1.005,3.207),P=0.048]affected the clinical pregnancy rate of FET.The multivariate analysis showed that usage of HCG was still the influencing factor of clinical pregnancy rate after adjusting for confounding factors[OR=2.266,95%CI(1.069,4.804),P=0.033].Conclusions:Intramuscular injection of HCG before endometrium transformation in FET cycle with down-regulation hormone replacement protocol is helpful to improve the clinical pregnancy rate and embryo implantation rate.