多囊卵巢综合征患者再次冻融胚胎移植内膜准备方案策略

目的:探讨来曲唑促排卵及移植前预处理对多囊卵巢综合征(PCOS)患者再次冻融胚胎移植内膜准备及妊娠成功率的影响。方法:对尚有冷冻胚胎的26例PCOS初次冻融胚胎移植妊娠失败患者,应用来曲唑促排卵法作为子宫内膜准备方法,并对宫腔异常者行宫腔镜检查及治疗,对移植困难者行扩宫治疗,再次移植前常规行宫腔刺激,观察冷冻复苏移植的效果。结果:诱发排卵日E2平均水平为(326±229)pg/ml,较前次激素替代周期E2值增加,差异有统计学意义(P<0.05)。前次10例E2<100 pg/ml者经促排卵后6例临床妊娠;子宫内膜厚度、移植胚胎数和胚胎复苏率与前次移植差异无统计学意义(P>0.05),其中宫腔息肉摘除者3例均妊娠成功,移植困难者经扩宫后2例妊娠,本次移植临床妊娠率为53.84%(14/26)。结论:对于PCOS行人工周期内膜准备冻胚移植失败的患者,再次移植时可采用来曲唑促排卵,联合移植前宫腔及宫颈预处理可提高再次冻胚移植的成功率。

Endometrial preparation scheme of the second frozen-thawed embryo transplantation in patients with polycystic ovary syndrome

Objective:To explore the effect of the ovulation induction with letrozole(LE) and pretreatment of endometrial preparation in the second frozen-thawed embryo transplantation in patients with polycystic ovary syndrome(PCOS) on endometrial preparation and clinical pregnancy rate.Methods:Twenty-six patients with PCOS and unsuccessful frozen embryo transplantation in the hospital received ovulation induction with letrozole as endometrial preparation,while hysteroscopy was conducted for diagnosis and treatment among the patients with abnormal uterine cavity.Dilation therapy was carried out for these difficult transplantation patients,and the uterine stimulation was applied for the second transplantation.The effect of frozen-thawed embryo transplantation was observed.Results:The level of estradiol was(326±229) pg/ml on the induced ovulation day,which was statistically significantly higher than that during the last hormone replacement period(P<0.05).Among 10 patients,six patients with estradiol level<100 pg/ml got pregnancy after ovulation induction.There was no statistically significant difference in the thickness of endometrium,frozen embryo transplantation cycles,and the recovery rate of frozen embryos(P>0.05).Three patients with uterine polyp after excision of cervical polyp and two patients with difficult transplantation after uterine dilation got pregnancy successfully.The pregnancy rate was 53.84%.Conclusion:For the patients with PCOS and unsuccessful frozen embryo transplantation,the induction of ovulation with letrozole,uterine and cervical pretreatment at the second transplantation is necessary for improving the transplantation success rate.