3种不同超促排卵方案对冻融胚胎移植结局的影响

目的:探讨不同超促排卵方案全部胚胎冷冻后行冻融胚胎移植(FET)的临床妊娠结局。方法:回顾性分析360例患者全胚胎冷冻后复苏移植周期的临床结局。按促排卵方案分为3组,A组:GnRH-a长方案组(n=131),B组:GnRH-a短方案(n=110),C组:CC+hMG组(n=119),按年龄段(<35岁,≥35岁)分别比较3组的促排卵效果及妊娠结局,并且以基础FSH(bFSH)=10 IU/L为界,把C组患者分为bFSH<10 IU/L和bFSH≥10 IU/L 2个亚组,比较其促排卵效果及妊娠结局。结果:C组获卵数、Gn使用总量、Gn用药天数显著低于A和B组(P<0.05),受精率和优质胚胎率高于A和B组(P<0.05);不同年龄段中C组与A和B组的临床妊娠结局均无统计学差异。3组的临床妊娠率分别为42.5%、35.6%、38.9%,胚胎种植率分别为23.9%、21.9%、17.2%,组间无统计学差异(P>0.05)。C组中bFSH≥10 IU/L亚组与bFSH<10 IU/L亚组的促排卵效果及妊娠结局无显著差异(P>0.05)。结论:CC+hMG方案在全部胚胎冷冻后行FET的患者中能取得与GnRH-α长、短方案相似的临床效果,同时Gn的用量大大低于长、短方案组,降低了药物对卵巢过度刺激造成的并发症,减轻了患者的经济和心理负担。

Comparison of Frozen-thawed Embryo Transfer Pregnancy Outcome among 3 Protocols of Controlled Ovarian Hyperstimulation

Objective: To investigate the frozen-thawed embryo transfer(FET) outcomes of clomiphene minimal stimulation in patients with all embryos cryopreservation.Methods: A total of 360 patients with whole embryo cryopreservation were retrospectively analyzed and then FET was performed.All patients were divided into 3 groups,group A: GnRHa long protocol(131 cases),group B: GnRHa short protocol(110 cases),group C: colmiphene minimal stimulation protocol(119 cases).The efficacy of induced ovulation and pregnancy outcome were compared among the 3 groups according to the age(< 35 years,≥ 35 years).In group C,the patients were divided into two sub-groups according to the basic FSH value(bFSH = 10 IU/L) and their ovulation and pregnancy outcome were compared.Results: In group C,the number of retrieved oocytes,dose of Gn,Gn duration were significantly lower than those of groups A and B(P<0.05) and the fertilization rate and good quality embryo rate were higher than those in groups A and B(P<0.05).Group C and group A,B showed no significant difference in clinical outcome of pregnancy in different age.The total clinical pregnancy rate and implantation rate of groups A,B,C were respectively 42.5%,35.6%,38.9% and 23.9%,21.9%,17.2%.In group C,bFSH >10 IU/L sub group and bFSH <10 IU/L sub group showed no significant difference in ovulation efficacy and pregnancy outcome.Conclusion: The minimal stimulation protocol can acquire similar clinical effect in the all embryo cryopreservation and then FET patients with GnRH-a long/short protocol,at the same time,the dosage of Gn is significantly lower and complications caused by ovarian hyperstimulation is reduced,lightening the patients’economic and mental burden.