冷冻胚胎移植周期中不同内膜准备方案对助孕结局的影响

目的：探讨冷冻胚胎移植（FET）周期中,3种内膜准备方案对治疗不孕的临床妊娠率、自然流产率、周期取消率的影响。方法选择2011年1~12月在北京大学深圳医院生殖医学科接受 FET 的323例患者的病历资料为研究对象,并对其进行回顾性分析。按照不同内膜准备方案,将其分别纳入自然周期组（n=89,采用自然周期内膜准备方案）,诱导排卵周期组（n=110,采用来曲唑诱导周期内膜准备方案）,激素替代治疗（HRT）周期组（n=124,采用雌、孕激素 HRT内膜准备方案）。本研究排除标准：合并输卵管积水、子宫内膜异位症、子宫腺肌症、子宫内膜息肉及卵巢储备功能低下者。本研究遵循的程序符合北京大学深圳医院人体试验委员会所制定的伦理学标准,得到该委员会批准。结果3组患者年龄、不孕年限、体质量指数、移植日内膜厚度、移植胚胎数及优质胚胎率等比较,差异均无统计学意义（P＞0.05）。在临床助孕结局方面,3组患者的临床妊娠率、自然流产率、胚胎种植率、异位妊娠发生率及多胎发生率等比较,差异均无统计学意义（P＞0.05）；而自然周期组患者的周期取消率（非胚胎因素）明显高于诱导排卵周期组与 HRT周期组,且差异均有统计学意义（P＜0.05）。结论在 FET周期中,3种内膜准备方案各有其优缺点。如何根据受试者具体情况选择个性化的内膜准备方案,尚待进一步研究证实。

Effects on Outcomes of Different Kinds of Endometrial Preparation Methods in Frozen Embryo Transfer Cycles During in Vitro Fertilization-Embryo Transfer

Objective To investigate difference of clinical pregnancy rates,spontaneous abortion rates,cycle cancellation rates among three kinds of endometrial preparation methods during frozen embryo transfer （FET）cycles when treating infertility.Methods Retrospective analysis was conducted in 323 FET cases in Department of Reproductive Medicine,Shenzhen Hospital of Peking University from January to December,2011. They were divided into three groups according to different kinds of endometrial preparation methods,natural cycle group（n= 89）,induced ovulation cycle group（n=110）,and hormone replacement therapy（HRT）cycle group（n=124）.Exclusion criteria in this study included concurrent of hydrosalpinx,endometriosis and adenomyosis,endometrial polyps and poor ovarian reserve.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Shenzhen Hospital of Peking University.Results There had no significant differences in three groups among age,duration of infertility,body mass index,intima-medial thickness on transfer day,and the number and quality of transfer embryo （P〉0.05）.There had no significant differences in three groups among clinical pregnancy rates, spontaneous abortion rates,implantation rates,ectopic pregnancy rates and multiple pregnancy rates（P〉0.05）.Rate of cycle cancellation （with embryo factor excluded）in natural cycle group was much higher than that in induced ovulation cycle group and HRT cycle group,respectively （P〈0.05）.Conclusions During FET cycle, three kinds of endometial preparation methods have their advantages and disadvantages. Therefore,further studies are needed to select the personalized endometrial preparation under individual conditions.