人工周期中延长雌激素治疗时间可降低冻融胚胎移植的活产率

Prolonged estrogen(E2)treatment prior to frozen-blastocyst transfer decreases the live birth rate

目的通过对月经规律患者采用人工周期准备子宫内膜进行冻融胚胎移植(FET)的临床结局分析,比较不同的雌激素作用时间对妊娠结局的影响。方法回顾性分析秦皇岛市妇幼保健院生殖医学中心2017年7月至2019年10月以人工周期准备子宫内膜,黄体酮转化子宫内膜日内膜厚度≥7mm时行复苏移植2个优质囊胚的月经规律患者共126个周期的临床资料。用黄体酮前雌激素应用天数按4分隔点分为四组:≤21天、22~28天、29~35天、36~48天组,比较不同雌激素应用天数的一般情况和妊娠结局。结果雌激素的持续时间对活产率有显著影响,当雌激素持续29~35天和36~48天,和对照组相比出现显著下降(OR=0.35;95%CI[0.09-1.41];OR=0.19;[0.03-1.32]),但四组间临床妊娠率、早期妊娠丢失率无统计学差异(P>0.05)。结论与雌激素持续时间少于21天组相比,超过28天的雌激素治疗可以降低囊胚移植的活产率(LBR)。

Objective:To explore the optimum estrogen given days in frozen-thawed blastocyst transfer cycle for patients.Methods:A retrospective study was conducted in 126 frozen-thawed blastocyst transfer cycles of patients with regular menstruation in hormone replacement of Department of Reproduction and Genetics in Qinhuangdao Maternal and Child Health Care Hospital from July 2017 to October 2019.Two high quality blastocysts were transferred,and endometrium thickness was more than 7 mm.The cycles were divided into four groups according to estrogen given days:≤21Days group,22-28days group,29-35days group,36-48days group.The pregnancy outcomes were compared among these groups.Results:Live birth rate(LBR)significantly decreased when the E^2 exposure prior to the frozen-thawed blastocyst transfer exceeded 28 days:OR=0.35;95%CI[0.09-1.41];OR=0.19;[0.03-1.32];There were no significant differences in the early pregnancy loss rate,clinical pregnancy rate between four groups.Conclusion:LBR Compared with E^2 less than 21 days group,significantly decreased when the E^2 exposure prior to the frozen-thawed blastocyst transfer exceeded 28 days.