早期子宫内膜癌和子宫内膜非典型增生患者保守治疗后的IVF-ET治疗结局

目的分析早期子宫内膜癌和子宫内膜非典型增生患者应用保留生育功能治疗并放置左炔诺孕酮宫内节育系统(曼月乐)后进行IVF-ET助孕的临床情况和胚胎体外培养结局。方法收集经保守治疗后完全缓解,于2017年10月至2020年4月期间转诊至我院生殖中心进行辅助生殖治疗的34例早期子宫内膜癌和子宫内膜非典型增生患者资料共57个IVF周期作为研究组,根据年龄、BMI、不孕原因、促排卵方案等在同时期匹配114个子宫内膜正常的IVF周期作为对照组。比较两组患者的基本资料、促排卵情况和胚胎体外培养情况。结果两组患者基本资料中年龄、BMI、不孕年限、基础激素水平(FSH、E2、PRL、LH)均无显著差异(P>0.05),仅研究组基础睾酮(T)水平显著低于对照组(1.16±0.72)nmol/L vs.(1.71±0.68)nmol/L,P<0.001]。研究组较对照组Gn起始剂量(271.2±56.3)U vs.(247.0±63.7)U]和总量(3534.4±1263.3)U vs.(3104.9±1282.2)U]显著增高(P<0.05),研究组HCG日内膜厚度较对照组薄(7.07±2.08)mm vs.(11.57±2.38)mm,P<0.05];两组间Gn天数无显著差异(P>0.05);HCG日激素水平除FSH无显著差异(P>0.05)外,其他所检测的激素水平(E 2、P、T、LH)在研究组均显著低于对照组(P<0.05)。两组间获卵数(9.0±5.8)vs.(10.4±6.4)]、MII卵数(7.9±5.4)vs.(9.1±6.1)]、受精率(90.42%vs.90.50%)、卵裂率(99.75%vs.99.26%)和优质胚胎率(10.37%vs.10.58%)均无显著差异(P>0.05);研究组囊胚形成率显著高于对照组(47.41%vs.40.75%,P<0.05)。34位患者中有19位进行了共27个周期的冻融胚胎移植,每移植周期的妊娠率为44.4%(12/27),累积妊娠率为63.2%(12/19)。结论子宫内膜病变保守治疗后体外受精过程与其他患者类似,对于存在不孕病史的早期子宫内膜癌和子宫内膜非典型增生患者,保守治疗后体外受精-胚胎移植可以提供可靠的生育结局。

IVF-ET outcome in patients with early endometrial cancer and atypical endometrial hyperplasia after conservative treatment

Objective:To analyze the clinical situation and the IVF-ET outcome in patients with early endometrial cancer and atypical endometrial hyperplasia after fertility preservation treatment and placement of levonorgestrel-releasing intrauterine system(Mirena).Methods:A total of 57 IVF cycles were collected from 34 patients with early endometrial cancer and atypical endometrial hyperplasia,who were complete remission after conservative treatment and referred to the reproductive center of our hospital for assisted reproductive therapy from October 2017 to April 2020 as the study group.At the same period,114 IVF cycles with normal endometrium were matched according to age,BMI,infertility causes,ovulation induction program as the control group.The basic information,the status of ovulation induction and embryo culture in vitro were compared between the two groups.Results:There was no significant difference in age,BMI,infertility years,basic levels of FSH,E 2,PRL,LH between the two groups(P>0.05),while basic testosterone(T)levels of the study group were significantly lower than those of the control group(1.16±0.72)nmol/L vs.(1.71±0.68)nmol/L,P<0.001].The initial doses(271.2±56.3)U vs.(247.0±63.7)U]and total doses(3534.4±1263.3)U vs.(3104.9±1282.2)U]of Gn in the study group were significantly higher than those in the control group(P<0.05).Endometrial thickness on HCG day of the study group was significantly thinner than that of the control group(7.07±2.08)mm vs.(11.57±2.38)mm,P<0.05].There was no significant difference in Gn days between the two groups(P>0.05).The hormone levels(E 2,P,T,LH)on HCG day were significantly lower than those in the control group(P<0.05),but FSH levels were not significant different(P>0.05).There was no significant difference in oocyte retrieved number(9.0±5.8)vs.(10.4±6.4)],MII oocyte number(7.9±5.4)vs.(9.1±6.1)],fertilization rate(90.42%vs.90.50%),cleavage rate(99.75%vs.99.26%)and high-quality embryo rate(10.37%vs.10.58%)between the two groups(P>0.05).The blastocyst formation rate in the study group was significantly higher than that in the control group(47.41%vs.40.75%,P<0.05).Nineteen out of 34 patients underwent 27 cycles of vitrified-thawed embryo transfer,with a pregnancy rate of 44.4%(12/27)per cycle and a cumulative pregnancy rate of 63.2%(12/19).Conclusions:The IVF process after conservative treatment of endometrial lesions is similar to that of other patients.For patients with early endometrial cancer and atypical endometrial hyperplasia with a history of infertility,IVF-ET can provide reliable reproductive outcomes after conservative treatment.