不同内膜准备方案在OHSS高风险患者首次FET中的应用比较

目的　探讨不同子宫内膜准备方案对卵巢过度刺激综合征（OHSS）高风险患者全胚冷冻后首次冻融胚胎移植（FET）治疗结局的影响。方法　选取2019年1月至2020年10月在广州市第一人民医院行体外受精-胚胎移植（IVF-ET）、因OHSS高风险行全胚冷冻患者共226名。根据内膜准备方案不同分为自然周期（NC）组74名，年龄（30.65±4.80）岁，激素替代周期（HRT）组108名，年龄（29.79±4.41）岁，降调节激素替代周期（GnRHa+HRT）组44名，年龄（30.03±4.56）岁。比较3组患者年龄、不孕年限、体质量指数（BMI）、基础性激素、抗苗勒管激素（AMH）、平均移植胚胎数、胚胎种植率、临床妊娠率、异位妊娠率、早期流产率、多胎妊娠率，采用方差分析和χ²检验进行统计分析，P<0.05为差异有统计学意义。结果　3组患者年龄、不孕年限、BMI、基础性激素、AMH、平均移植胚胎数、胚胎种植率等均差异均无统计学意义（均P>0.05）；HRT组移植日子宫内膜厚度为（9.80±1.61）mm，明显低于NC组［（11.07±1.71）mm］和GnRHa+HRT组［（10.23±1.66）mm］，差异有统计学意义（F=7.509，P=0.001），NC组和GnRHa+HRT组差异无统计学意义（P>0.05）；HRT组囊胚所占比例为47.22%（51/108），明显高于NC组的32.43%（24/74），差异有统计学意义（P<0.05），NC组和GnRHa+HRT组差异无统计学意义（P>0.05）。3组患者的临床妊娠率、异位妊娠率、早期流产率、多胎妊娠率比较均差异均无统计学意义（均P>0.05）。结论　OHSS高风险患者FET采用3种内膜准备方案的临床妊娠效果差异无统计学意义，建议医生根据不孕症患者的实际情况选择个体化方案以获得理想的妊娠结局。

Application of different endometrial preparation protocols in first FET in patients with high-risk of OHSS

Objective　To investigate the effects of different endometrial preparation protocols on the outcomes of first frozen-thawed embryo transfer (FET) in patients with high risk of ovarian hyperstimulation syndrome (OHSS) after whole embryo freezing. Methods　A total of 226 patients who underwent in vitro fertilization-embryo transfer (IVF-ET) and whole embryo freezing due to high risk of OHSS in Guangzhou First People's Hospital from January 2019 to October 2020 were selected. According to different endometrial preparation protocols, the patients were divided into a natural cycle (NC) group 74 cases who were (30.65±4.80) years old], a hormone replacement cycle (HRT) group 108 cases who were (29.79±4.41) years old], and a down-regulated hormone replacement cycle (GnRHa+HRT) group 44 cases who were (30.03±4.56) years old]. The ages, years of infertility, body mass indexes (BMI), basal sex hormones, anti-Müllerian hormone (AMH), average numbers of embryos transferred, embryo implantation rates, clinical pregnancy rates, ectopic pregnancy rates, early miscarriage rates, and multiple pregnancy rates were compared between these three groups. Analysis of variance and χ² test were used for the statistical analysis. The difference was considered statistically significant when P < 0.05. Results　There were no statistical differences in age, years of infertility, BMI, basal sex hormones, AMH, average number of transferred embryos, and embryo implantation rate between the three groups (all P>0.05). The endometrial thickness on the day of transplantation in the HRT group (9.80±1.61) mm] was significantly lower than those in the NC group (11.07±1.71) mm] and the GnRHa+HRT group (10.23±1.66) mm], with a statistical difference (F=7.509,P=0.001); there was no statistical difference between the NC group and the GnRHa+HRT group (P>0.05). The proportion of blastocysts in the HRT group was significantly higher than that in the NC group 47.22% (51/108) vs. 32.43% (24/74)], with a statistical difference (P<0.05); there was no statistical difference between the NC group and the GnRHa+HRT group (P>0.05). There were no significant differences in the clinical pregnancy rate, ectopic pregnancy rate, early miscarriage rate, and multiple pregnancy rate between the three groups (all P>0.05). Conclusions　There is no significant difference in the clinical pregnancy effect between the three endometrial preparation protocols for the first frozen-thawed embryo transfer in patients with high risk of OHSS after whole embryo freezing. It is recommended that doctors choose an individualized protocol according to the actual situation of infertile patients to obtain ideal pregnancy outcomes.