不同内膜准备方案对多囊卵巢综合征患者冻融胚胎移植周期临床结局的影响

目的:探讨不同子宫内膜准备方案对多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期临床结局的影响。方法:回顾性分析2016年1月—2017年12月于南京医科大学附属妇产医院生殖中心行FET的633例PCOS患者的病历资料,根据内膜准备方案分为促排卵组(A组,61例)、激素替代组(B组,347例)、降调节+激素替代组(C组,225例),比较3组患者的基本情况及妊娠结局。结果:3组患者的年龄、不孕时间、体质量指数(BMI)、基础卵泡刺激素(FSH)水平、雌二醇(E2)水平、移植胚胎数、优质胚胎数、囊胚占比差异均无统计学意义(P>0.05)。C组基础黄体生成激素(LH)水平高于B组,FET周期始用药时LH、FSH、E2水平均明显低于A、B组,转化日子宫内膜厚度高于A、B组(P<0.05),3组间胚胎种植率、临床妊娠率和多胎妊娠率差异无统计学意义(P>0.05)。A组早期流产率低于B、C组,B组的异位妊娠率低于C组,差异有统计学意义(P<0.05)。B组与C组间雌激素用量及用药时间差异均无统计学意义(P>0.05)。结论:对于PCOS患者,促排卵、激素替代、降调节+激素替代3种内膜准备方案均能获得较好的FET临床结局,促排卵和激素替代方案在降低早期流产率和异位妊娠率方面各具优势。

Effect of Various Endometrial Preparation Protocols in Frozen-Thawed Embryo Transfer Cycles on the Clinical Outcomes of the Patients with Polycystic Ovarian Syndrome

Objective：To investigate the effects of different endometrial preparation protocols in frozen-thawed embryo transfer (FET) cycles on the clinical outcomes of the patients with polycystic ovarian syndrome (PCOS). Methods: The data of 633 FET cycles of PCOS patients from January 2016 to December 2017 were analyzed retrospectively. According to endometrial preparation protocols, the patients were grouped into the　ovulation induction group（group A，n=61）, the hormone replacement group（group B，n=347）and the pituitary down-regulation combined with hormone replacement group （ｇｒoup C，n=22５）． Ｔhe basic characteristics and the pregnancy outcomes were compared among three groups. Results: There were no significant differences in the age，time of infertility, body mass index, basic FSH level, E2 level, the number of transfered embryos，the rate of embryo implantation, the clinical pregnancy rate and the multiple pregnancy rate among three groups （all P＞0.05）. The basic level of LH in the group C was higher than that in the group B (P＜0.０５），ａnd endometrial thickness on the day of embryo transfer in the group C was higher than those in the group A and the group（both P＜0.05）. The levels of LH, FSH, and E2 before hormone administration in the group C were significantly lower than those in the group A and group B （ａｌl P＜0.0５）． The early abortion rate in the group A was significantly lower than those in the group B and the group C（P＜0.05），and the ectopic pregnancy rate in the group B was significantly lower than that in the group C（P＜0.05）. Furthermore, there were no significant differences in the duration and total dosage of estrogen administrated between the group B and the group C（P＞0.05）. Conclusions: For the patients with PCOS undergoing FET, the endometrial preparation protocols such as ovulation induction, hormone replacement and down regulation combined with hormone replacement can obtain satisfactory pregnancy outcomes，and the first two strategies have their own advantages in reducing the early abortion rate and the ectopic pregnancy rate.