芬吗通在冻融周期子宫内膜发育不良患者中的应用

目的探讨子宫内膜发育不良患者在冻融胚胎移植(FET)周期中行芬吗通激素替代方案时血清雌二醇(E_2)水平、内膜厚度与胚胎种植结局的关系,并分析不同17β雌二醇剂量和用药方式对血清E_2水平、内膜厚度和种植结局的影响。方法回顾性分析子宫内膜发育不良患者(曾行戊酸雌二醇激素替代方案因内膜厚度未达标而取消周期)行芬吗通激素替代方案的41个FET周期,根据临床结局分为着床组与未着床组,分析胚胎种植结局与血清E_2水平和内膜厚度的关系。并根据不同雌激素剂量和用药方式分为三组:A组仅口服雌激素6 mg,B组口服雌激素4 mg+阴道给药2 mg,C组口服雌激素6mg+阴道给药2 mg。三组两两比较其血清E2水平、内膜厚度和妊娠结局是否有差别。结果胚胎着床组与未着床组比较,两组患者的年龄、不育年限、移植胚胎数、优质胚胎数、基础E_2水平、移植日E_2水平、注射黄体酮第3日(D3)E_2水平、用药第7天内膜厚度和移植日内膜厚度均无统计学差异(P>0.05)。着床组的内膜增厚值明显大于未着床组,且差异有统计学意义(P<0.05)。B、C组分别与A组相比,移植日E_2水平、注射黄体酮D3日E_2水平和内膜增厚值均明显增加,且差异有统计学意义(P<0.05)。而C组与B组相比,除内膜增厚值明显增加且差异有统计学意义外(P<0.05),其余指标差异均无统计学意义(P>0.05)。结论在FET周期中,芬吗通激素替代方案适合用于子宫内膜发育不良患者,其血清E2水平、子宫内膜厚度、胚胎种植率和临床妊娠率均可达到满意效果。内膜增厚值是影响FET结局的重要因素之一。雌激素用药剂量与方式以口服17β雌二醇4 mg+阴道给药2 mg比较适宜内膜生长及胚胎种植。

Application of Femoston in frozen embryo transfer cycle in patients with endometrial dysplasia

Objective： To investigate the relationship between embryo implantation outcome and serum estradiol （E2） levels, endometrial thickness in patients with endometrial dysplasia in frozen embryo transfer cycles through hormone replacement therapy （HRT）with Femoston, and to analyze the effect of using the different dose and mode of 17β estradiol on serum E2 levels, endometrial thickness and embryo planting outcomes. Methods： Forty-one frozen embryo transfer cycles through HRT with Femoston were retrospectively analyzed in patients with endometrial dysplasia who were canceled cycle due to thin endometrium through hormone replacement program with progynova. The relationship between serum E2 levels and endometrial thickness was investigated in two groups including the implantation group and non-implantation group according to clinical outcome. All the patients were divided into three groups： group A （oral estrogen 6 mg）,group B（oral estrogen 4 rag＋ vaginal estrogen 2 rag）, and group C（oral estrogen 6mg＋ vaginal estrogen 2 mg）. The differences of their serum E2 levels, endometrial thickness and pregnancy outcome were compared among the three groups. Results： There were no statistical difference in patients＇ age, infertile years, number of embryos transferred, high-quality embryos, basic E2 level, E2 levels on transplant day and the third day after injection of progesterone, endometrial thickness on the seventh days after medication and the transplant day between embryo implantation group and non-implantation group （P〈 0.05）. The endometrium was significantly thicker in implantation group than non-implantation group （P〈0.05）. E21evels on transplant day, E21evels on the third day after injection of progesterone and endometrial thickness were significantly increased in group A compared with group B or C（P〈0.05）. In addition to endometrial thickness to be significantly increased（P（0.05） ,other indexes showed no significant differences in group C compared with group B. Conclusions： It is suitable for patients with endometrial dysplasia in frozen embryo transfer cycles through hormone replacement therapy with Femoston, and the serum E2 levels, endometrial thickness and embryo implantation and clinical pregnancy rates could achieve satisfactory results. The endometrial thickness is an important factor to influence the frozen embryo transfer outcome. The administration of 17β estradiol by oral 4mg and vaginal 2mg is more suitable for the endometrial growth and embryo implantation.