人工周期准备子宫内膜进行复苏囊胚移植的影响因素分析

Analysis of the clinical factors for frozen-thawed blastocyst transfer in hormonally controlled cycles

目的探讨采用人工周期准备子宫内膜进行复苏囊胚移植影响临床结局的相关因素。方法对2004年3月至2007年2月期间，采用人工周期准备子宫内膜的192个复苏囊胚移植周期进行回顾性分析。结果年龄及是否患有多囊卵巢综合征（PCOS）与移植后的妊娠结局相关（分别为P=0．027，OR值1．647及P=0．037，OR值0．437）。随年龄增加妊娠率和种植率呈下降趋势（≤30岁：61．4％和44．1％；31～34岁：53．8％和36．6％；≥35岁：39．0％和25．3％）。PCOS患者妊娠率和种植率分别为37．8％和25．0％，明显低于非PCOS患者（58．2％、42．5％）。戊酸雌二醇（E2V）起始剂量及用黄体酮前E2V的用药天数、总量与妊娠结局无关。结论年龄以及是否患有PCOS与妊娠结局相关，年轻的、非PCOS患者有较好的临床结局；并强调用药的个体化。

Objectives： To analyze how the clinical factors affect the outcomes of frozen-thawed blastocyst transfer in hormonally controlled cycles without prior GnRH agonist suppression. Methods： This retrospective study included 192 frozen-thawed blastocyst transfer cycles （FET, 338 blastocysts involved）. These cycles used estradiol valerate and progesterone preparations without the concomitant use of GnRHa, performed from March 2004 to February 2007 in our reproductive center. The relationship was analyzed with logistic regression between clinical outcomes and impact factors such as age, initiated dosage, estrogen duration before progesterone administered and the cause of infertility. Results. Of 192 FET cycles, 14 cycles （7.3%） were canceled. The pregnancy rate per ET and implantation rate were 53. 9% （96/178） and 38. 8% （131/338） respectively. With the age increased, the pregnancy rate and implantation rates declined （≤30y; 61.4% and 44. 1%; 31-34y. 53. 8% and 36. 6%; ≥ 35y： 39. 0% and 25.3%, respectively）. There were significant differences between patients without PCOS and those with PCOS in pregnancy rate and implantation rate （58. 2% and 42.5% vs. 38. 7% and 25.0% respectively）. There was no relationship between clinical outcomes and the initiated dosage, duration and total dosage. Conclusions： There was a relationship between clinical outcomes and age, the cause of infertility （with or without PCOS）. It seemed that younger patients and the patients without PCOS had more favorable clinical outcomes.