GnRHa在冻融周期胚胎反复种植失败患者中的应用

目的：探讨促性腺激素释放激素激动剂（gonadotrophin releasing hormone agonist，GnRHa）降调节后对冻融周期胚胎反复种植失败患者子宫内膜容受性及临床结局的影响。方法：回顾性分析2014年1月-2015年8月在广西医科大学第一附属医院生殖医学中心及柳州市人民医院生殖医学中心行131例冻融周期胚胎反复种植失败（≥2次）患者的临床资料，按子宫内膜准备方案分组，其中69例行单纯激素替代疗法（HRT）周期者为HRT组，62例GnRHa降调节联合HRT周期者为降调节组，从降调节组选取48例既往行HRT周期患者，与本周期进行自身配对比较。结果：HRT组与降调节组患者的年龄、不孕时间、基础性激素水平、体质量指数、子宫内膜厚度、移植胚胎数、移植优质胚胎数、优质胚胎率、早期流产率比较差异均无统计学意义（P＞0.05）。降调节组的临床妊娠率、胚胎着床率、子宫内膜A型血流者比例均高于HRT组（P＜0.05）。自身对照分析显示，不同内膜准备患者的子宫内膜厚度、优质胚胎率差异均无统计学意义（P＞0.05），但降调节者子宫内膜A型血流者比例显著高于单纯HRT周期（P＜0.05）。结论：GnRHa降调节联合HRT方案可以显著提高冻融周期胚胎反复种植失败患者的子宫内膜容受性和临床妊娠率。

Application of Gonadotrophin-releasing Hormone Agonist Pretreatment for the Women with Recurrent Implantation Failure in Frozen-thawed Embryo Transfer Cycles

Objective: To investigate the effects of gonadotrophin releasing hormone agonist (GnRHa) pretreatment on the outcomes of frozen-thawed embryo transfer (FET) cycles and endometrial receptivity for the women with recurrent implantation failure. Methods: A total of 131 women undergoing FET cycles in the reproductive medical center of the First Affiliated Hospital of Guangxi Medical University and the People′s Hospital of Liuzhou with a history of recurrent implantation failure (≥2 times) were enrolled in this retrospective study from January 2014 to August 2015. According to the protocols of endometrial preparation, those women were grouped into two groups: the group A received only hormone replacement treatment (HRT) for endometrial preparation (69 cycles)，and the group B received GnRHa down-regulation pretreatment before HRT (62 cycles). Meanwhile，the 48 patients in group B who had received HRT for endometrial preparation previous FET cycle (sub-groups) were also performed the self-control comparison. Results: There were no statistical differences in the age, duration of infertility, basal endocrine level, body-mass index (BMI), endometrial thickness, number of embryo transferred, number of good-quality embryo, good-quality embryo rate, early abortion rate between the two groups (P＞0.05)，whereas the clinical pregnancy rate and implantation rate as well as the proportion of pattern A endometrial blood flow in group B were significantly higher than those in group A (P＜0.05). The self-control comparison showed that the proportion of pattern A endometrial blood flow was significantly higher in those cycles with GnRHa down-regulation than that in cycles with only HRT (P＜0.05)，and that there were no significant differences in endometrial thickness and the good-quality embryo rate between the two sub-groups (P＞0.05). Conclusions: GnRHa down-regulation pretreatment before HRT can significantly improve the endometrial receptivity and clinical pregnancy rate for the patients with recurrent implantation failure in FET cycle.