不同内膜准备方案的1372个冻融胚胎移植周期的临床治疗结局比较

Comparison of the effect of different endometrial preparation methods on the clinical outcome of 1 372 frozen-thawed embryos transfer

目的:比较不同内膜准备方案的冻融胚胎移植(frozen-thawed embryo transfer,FET)的临床治疗结局。方法:回顾性分析了南京医科大学第一附属医院2007年1月至2009年7月冻融胚胎移植共1372周期,其中自然周期冻融胚胎移植1014周期,微刺激周期冻融胚胎移植358周期,微刺激周期中人绝经期促性腺激素(HMG)方案127周期、克罗米芬+HMG方案77周期、来曲唑+HMG方案154周期。比较各组患者年龄、不孕年限、基础内分泌(FSH、LH、E2)水平、移植日内膜厚度、平均移植胚胎数、移植胚胎级别、胚胎种植率、生化妊娠率、临床妊娠率、早期流产率、晚期流产率、活产率差异。结果:自然周期和微刺激周期冻融胚胎移植在胚胎种植率(26.7%vs31.5%)、生化妊娠率(50.2%vs57.5%)、临床妊娠率(43.5%vs51.1%)、活产率(38.0%vs44.9%)差异有统计学意义(P<0.05),早期流产率(9.3%vs9.8%)、晚期流产率(1.8%vs1.6%)、异位妊娠率(1.6%vs0.5%)差异无统计学意义;微刺激周期各用药组之间胚胎种植率、生化妊娠率、临床妊娠率、流产率及活产率差异无统计学意义。结论:适当的自然周期内膜监测或药物微刺激促排卵周期行FET内膜准备,较适合于冻融胚胎的移植。

Objective：To compare the effect of different endometrial preparation methods on the clinical outcome of frozen-thawed embryo transfer （FET）.Methods：Total 1 372 FET cycles from January 2007 to July 2009 were retrospectively analyzed and divided into two groups：natural cycle group （n=1 014）and ovulation induction cycle group （n=358）.The latter was further divided into three Sub groups：HMG cycle group（n=127）,clomiphene citrate＋ HMG cycle group（n=77） and letrozole＋HMG cycle group（n=154）.The pa-tient age,duration of infertility,basal FSH,LH and E2 levels,number of embryo transferred,embryo quality and endometrial thickness,the rates of embryo implantation,biochemical pregnancy,clinical pregnancy,early abortion,late abortion and live births were compared be-tween these different groups.Results：FET cycle outcomes were similar between the nature cycle group and the ovulation induction cycle group on early abortion rates （9.3% vs 9.8%,P〉0.05）,late abortion rates （1.8% vs 1.6%,P〉0.05） and ectopic pregnancy r ates （1.6% vs 0.5%,P〉0.05）.There were significant differences of the rates of embryo implantation （26.7% vs 31.5%,P〈0.05）,biochemical pregnancy （50.2% vs 57.5%,P〈0.05）,clinical pregnancy （43.5% vs 51.1%,P〈0.05） and live births （38.0% vs 44.9%,P〈0.05） between the two groups.The clinical pregnancy rates of three ovulation induction cycle groups were 54.5%,51.9%,42.8%,re-spectively in letrozole＋HMG cycle group,the HMG group and the clomiphene citrate＋HMG group.There were no significant differences among them.Conclusion：Endometrial preparation of natural cycle or proper ovulation induction cycle are very suitable for FET.