降调节联合人工周期方案在冻融胚胎移植周期中的应用

目的:探讨降调节联合人工周期方案对冻融胚胎移植助孕周期临床妊娠结局的影响。方法:收集到行冻融胚胎移植助孕治疗的297个周期,按不同内膜准备方案分组,133例降调节联合人工周期为降调节组,164例行单纯人工周期为人工周期组进行比较分析,同时对部分2种方案均实施过的同一患者进行自身对照分析,并对影响降调节联合人工周期的妊娠结局进行多因素回归分析。结果:患者的年龄、不孕年限、基础FSH、体质量指数(BMI)、内膜厚度、移植胚胎数、优质胚胎数、优质胚胎率、多胎率、异位妊娠率、早期流产率组间均无统计学差异(P>0.05)。降调节组的临床妊娠率、胚胎着床率分别为42.11%(56/133)、24.32%(81/333),显著高于人工周期组的29.88%(49/164)、13.83%(52/376),差异有统计学意义(P<0.05)。自身对照分析显示患者的内膜厚度、优质胚胎率均无统计学差异(P>0.05),但降调节联合人工周期的临床妊娠率52.17%(24/46)]显著高于单纯人工周期的13.04%(6/46)],差异有统计学意义(P<0.05)。另外,Logistic回归分析显示,优质胚胎数、手术史可影响妊娠结局。结论:在临床上,对于既往有盆腔手术史、多次冻融周期助孕失败史的患者,可试行降调节联合人工周期方案进行助孕。

Application of Gonadotrophin-releasing Hormone Agonist (GnRH-a) Combined Exogenous Steroid Supplementation in Frozen-thawed Embryo Thansfer Cycles

Objective: To explore the impact of gonadotrophin-releasing hormone agonist(GnRH-a) combined with exogenous steroid supplementation on clinical pregnancy outcome in frozen-thawed embryo transfer cycle.Methods: According to the different endometrial preparation protocols,297 frozen-thawed embryos transfer cycles were collected and analys,including 133 GnRH-a combined with exogenous steroid supplementation cycles as down-regulation group and 164 mere exogenous steroid supplement cycles as hormone replacement treatment (HRT) group,in addition to this,the patients who had used both of these protocols were analysed,what’s more,the logisitic regression for the relationship between clinical pregnancy and the related factors was done as to find the important factors.Results: There were no statistical differences between the two groups with regard to the age of the women,duration of infertility,basical FSH(follicle-stimulating hormone),BMI(body-mass index),endometrial thickness,number of embryos thansferred,number of good-quality embryo,good-quality embryo rate,multiple pregnancy rate,ectopic pregnancy rate,early abortion rate(P>0.05),however,compared with the patients from HRT group,the patients from down-regulation group achieved significantly higher clinical pregnancy rate 42.11%(56/133) vs 29.88%(49/164)]and implantation rate 24.32%(81/333) vs 13.83%(52/376)],and the difference was statistically significant(P<0.05).And for the same person who had used the two protocols,there was no significant difference between the two groups with regard to endometrial thickness,good-quality embryo rate(P>0.05),however,the clinical pregnancy outcomes of down-regulation group was better than the HRT group 52.17%(24/46) vs 13.04%(6/46)],and the difference was statistically significant(P<0.05).Furthermore,the result of Logisitic regression showed that the number of good-quality embryo and pelvic surgery history played an important role in pregnancy outcomes.Conclusion: In clinic,the protocol of gonadotrophin-releasing hormone agonist(GnRH-a) combined exogenous steroid supplementation was an additional method in endometrial preparation for the patient who had pelvic surgery history and repeated unsuccessful trial of exogenous steroid supplement.