4种内膜准备方案对PCOS患者冻胚移植妊娠结局的影响

Effect of four endometrial preparation protocols on the pregnancy outcomes after freeze-thaw embryo transfer in polycystic ovary syndrome patients

目的 探究4种不同的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)后妊娠结局的影响。方法 回顾性分析2015年1月至2020年12月在济宁市第一人民医院生殖医学科进行FET助孕的924例PCOS患者的临床资料,按照子宫内膜准备方法的不同将患者分成自然周期组(NC组,85周期)、促排周期组(127周期)、激素替代组(HRT组,635周期)和降调节+激素替代组(GnRH-a+HRT组,77周期)。比较四组患者的临床资料与助孕后的妊娠结果(包括临床妊娠率、胚胎种植率、异位妊娠率等)。结果 四组女方年龄、体重指数(BMI)、基础黄体生成素(LH)水平、抗苗勒管激素(AMH)水平、移植日子宫内膜厚度、移植胚胎数量比较均无显著性差异(P>0.05)。GnRH-a+HRT组临床妊娠率(70.1%)显著高于NC组(44.7%)、促排周期组(54.3%)和HRT组(53.9%);GnRH-a+HRT组胚胎着床率(54.3%)显著高于NC组(39.0%)、促排周期组(44.5%)和HRT组(42.6%);GnRH-a+HRT组活产率(54.5%)显著高于NC组(35.3%)、促排周期组(46.5%)和HRT组(39.5%)。而NC组、促排周期组、HRT组和GnRH-a+HRT组异位妊娠率(0%vs.0.8%vs.0.3%vs.0%)、早期流产率(5.9%vs.3.9%vs.9.3%vs.10.4%)、晚期流产率(3.5%vs.3.1%vs.4.7%vs.5.2%)比较均无显著性差异(P>0.05)。结论 PCOS患者采用GnRH-a+HRT方案准备内膜进行FET可获得良好的妊娠结局。

Objective To investigate the effects of four different endometrial preparation protocols on pregnancy outcomes after freeze⁃thaw embryo transfer(FET)in patients with polycystic ovary syndrome(PCOS).Methods The clinical data of 924 PCOS patients who received FET in Department of Reproductive Medicine of Jining No.1 People′s Hospital from January 2015 to December 2020 were retrospectively analyzed.According to different methods of endometrial preparation,they were divided into natural cycle group(NC group,n=85),stimulation cycle group(n=127),hormone replacement treatment group(HRT group,n=635)and hormone replacement treatment group after down regulation(GnRH⁃a+HRT group,n=77).The clinical data and the pregnancy results(clinical pregnancy rate,embryo implantation rate,ectopic pregnancy rate,etc.)of the four groups were compared.Results There were no significant differences in female age,body mass index(BMI),basal luteinizing hormone(LH)concentration,anti⁃Müllerian hormone(AMH),endometrial thickness on the transfer date,and number of colonized embryos between the four groups(P>0.05)。The clinical pregnancy rate(70.1%)in the GnRH⁃a+HRT group was significantly higher than that of NC group(44.7%),stimulation cycle group(54.3%)and HRT group(53.9%).The embryos implantation rate of GnRH⁃a+HRT group(54.3%)was significantly higher than that of NC group(39.0%),stimulation cycle group(44.5%)and HRT group(42.6%).The live birth rate of GnRH⁃a+HRT group was significantly higher than that of NC group(35.3%),stimulation cycle group(46.5%)and HRT group(39.5%).The ectopic pregnancy rate(0%vs.0.8%vs.0.3%vs.0%),early abortion rate(5.9%vs.3.9%vs.9.3%vs.10.4%)and late abortion rate(3.5%vs.3.1%vs.4.7%vs.5.2%)of the four groups have no significant difference(P>0.05).Conclusions For PCOS patients,GnRH⁃a+HRT protocol for preparing endometrium for FET could achieve good pregnancy results.