高龄不孕患者降调节后激素替代内膜准备方案对冻融胚胎移植周期妊娠结局的影响

目的：探讨降调节后联合激素替代和单纯激素替代2种内膜准备方法对高龄不孕患者冻融胚胎移植（FET）妊娠结局的影响，分析降调节后激素替代FET周期临床妊娠结局的影响因素，为高龄不孕患者冻融胚胎移植周期内膜准备方案的选择提供依据。方法：选择年龄≥35岁首次行FET高龄不孕患者211例，按子宫内膜准备方案分为降调节后激素替代周期组（n=114）和激素替代周期组（n=97）。回顾性分析2组患者年龄、不孕年限、体质量指数（BMI）、抗苗勒管激素（AMH）水平、基础性激素、转化日内膜厚度、移植胚胎数、移植优质胚胎数、移植优质胚胎率、多胎妊娠率、临床妊娠率和流产率，并对高龄不孕患者降调节后激素替代周期的妊娠结局影响因素进行二项Logistic回归分析。结果：2组患者年龄、不孕年限、BMI、AMH、移植胚胎数、移植优质胚胎数、移植优质胚胎率、多胎妊娠率和流产率比较差异无统计学意义（P>0.05）。降调节后激素替代周期组患者临床妊娠率及胚胎着床率均明显高于激素替代周期组（χ²=9.964，P<0.05；χ²=9.964，P<0.05）。二项Logistic回归分析，患者年龄（OR=0.805，95% CI：0.697~0.930）和移植优质胚胎数（OR=4.098，95% CI：1.597~10.514）是影响高龄不孕患者降调节后激素替代周期妊娠结局的关键因素。结论：采用降调节后激素替代周期的高龄不孕患者在FET中能得到更好的临床结局，年龄和移植优质胚胎数是影响高龄不孕患者降调节后激素替代周期妊娠结局的关键因素。

Effect of preparation plan of hormone replacement after down-regulation on pregnancy outcome of frozen-thawed embryo transfer cycle in advanced age infertile patients

Objective: To investigate the effects of two methods of endometrial preparation plans(hormone replacement after down regulationand hormone replacement) on the pregnancy outcome of frozen-thawed embryo transfer(FET) cycle in the advanced age infertile patients, and to analyze the influencing factors of pregnancy outcome of FET cycle of hormone replacement after down-regulation and to provide the basis for the selection of endometrial preparation scheme for FET cycle in the aged infertile patients. Methods: A total of 211 patients aged ≥ 35 years who first received FET treatment were selected.The patients were divided into hormone replacement cycle after down-regulation group(n=114) and hormone replacement cycle group(n=97).The age, duration of infertility, body mass index (BMI), anti-Mullerian hormone(AMH) level, basic sex hormones, endometrial thickness on the day of conversion, number of embryos transferred, number of high-quality embryos transferred, rates of high-quality embryos transferred,rates of multiple pregnancies, and abortion rates of the patients in two groups were analyzed, retrospectively, and the influencing factors of pregnancy outcome of hormone replacement cycle after down-regulating were analyzed by Binomial Logistic regression. Results: There were no significant differences in age, duration of infertility,BMI, AMH levels, number of embryos transferred, number of high-quality embryos transferred, rates of high-quality embryos transferred, rates of multiple pregnancies, and cycle abortion rates of the patients between two groups(P>0.05).The clinical pregnancy rate and embryo implantation rate of the patients in hormone replacement cycle after down-regulating group were significantly higher than those in hormene replacement cycle group(χ²=9.964,P<0.05;χ²=9.964,P<0.05). The results of Logistic regression analysis showed that age (OR=0.805,95%CI:0.697-0.930) and the number of high-quality embryos transferred (OR=4.098,95%CI:1.597-10.514) were the key factors influencing the pregnancy outcome of hormone replacement cycle after down-regulation in the advanced age infertile patients. Conclusion: Hormone replacement cycle after down-regulation can achieve the better clinical outcomes in FET in the advanced age infertility patients. Age and number of high-quality embryos transferred are the key factors affecting the pregnancy outcome of hormone replacement cycle after down-regulation in the advance age infertile patients.