子宫腺肌病冻融胚胎移植周期子宫内膜准备方案的选择

The choice of endometrial preparation protocols in frozen-thawed embryo transfer cycles for the patients with adenomyosis

目的探讨促性腺激素释放激素激动剂(GnRH-a)超长垂体降调节对改善子宫腺肌病(AM)患者冻融胚胎移植(FET)周期妊娠结局的价值。方法选择2008年1月至2010年9月在本生殖医学中心实施体外受精(IVF)或卵胞浆内单精子注射(ICSI)助孕后剩余胚胎冻存并择期行FET助孕的AM患者138例。根据FET前是否采用长效GnRH-a垂体降调节将患者分为GnRH-a+人工周期组,共106个周期;单纯人工周期组,共79个周期。比较两组患者的一般情况、性激素水平、注射黄体酮日子宫内膜厚度、胚胎移植日内膜形态、平均移植胚胎数、所移植的第3天(D3)卵裂期胚胎质量评分等指标,以及两组胚胎种植率、临床妊娠率和流产率差异。结果 (1)注射黄体酮日雌二醇(E_2)水平、内膜厚度,FET日孕酮(P)水平和内膜形态评分、平均移植胚胎数、复苏D3胚胎质量评分,两组比较均无显著差异(P>0.05)。(2)胚胎种植率、临床妊娠率,在GnRH-a+人工周期组分别为28.37%(61/215)、48.11%(51/106),单纯人工周期组分别为19.14%(31/162)、31.65%(25/79),两组比较均有显著性差异(P<0.05);流产率两组比较无显著差异(P>0.05)。结论 GnRH-a+人工周期子宫内膜准备方案明显提高AM患者FET周期胚胎种植率和临床妊娠率,而未增加流产率。

Objective. To evaluate the effect zen embryo transfer （FET） cycles in of different endometrial preparation the patients with adenomyosis. protocols on the outcomes of fro Methods： A total of 138 infertile women with adenomyosis who underwent FET cycles in this center from January 9.008 to September 2010 were included in this study. According to whether the prolonged GnRH-a down-regulation was employed, the patients were divided into GnRH-a plus artificial cycle group （106 cycles） and simple artificial cycle group （79 cycles）. Parameters of general information, sex hormone levels, endometrial thickness on the day of progesterone injection, endometrial condition on the day of FET, number and quality of transferred embryo, embryo implantation rate, clinical pregnancy rate and abortion rate were analyzed. Results： （1） There was no significant difference in serum levels of estradiol on the day of progesterone injection, endometrial thickness on the day of progesterone injection, progesterone levels on the day of FET, endometrial condition, average number of embryos transferred, average quality score of embryo transferred between two groups （P〉0.05）. （2） Embryo implantation rate and clinical pregnancy rate in GnRH-a plus artificial cycle group were 28. 37% （61/215） and 48. 11% （51/106）, respectively, and in simple artificial cycle group were 19. 14% （31/162） and 31.65% （25/79）, respectively, and the differences were significant between the two groups （P〈0.05）. There was no significant difference in abortion rate between two groups. Conclusions： GnRH-a plus artificial cycle for endometrial preparation before FET significantly improved the implantation rate and pregnancy rate in the patients with adenomyosis.