激素替代周期冻融胚胎移植术的安全性评价

Safety evaluation of frozen-thawed embryo transfer in hormone replacement cycles

目的评价激素替代周期冻融胚胎移植术(FET)口服大剂量戊酸雌二醇(E_2V)的安全性。方法回顾分析我中心2009年1月至2010年6月期间850个冻融胚胎移植周期,按内膜准备方式不同分为自然周期组(499个周期)和激素替代周期组(351个周期),比较两组的妊娠结局和子代出生情况。结果两组的临床妊娠率、异位妊娠率、流产率、早产率、单胎及多胎分娩率、低出生体重率、出生缺陷率、新生儿死亡率、男、女婴出生率,差异均无统计学意义(P>0.05),但激素替代周期组内分组发现,当戊酸雌二醇最大使用剂量>13 mg/d,移植前总剂量>201 mg时,临床妊娠率降低、异位妊娠率增加,差异具有统计学意义(P<0.05)。结论在冻融胚胎移植术中适当应用激素替代治疗短期内是安全有效的,但戊酸雌二醇超过一定剂量,可降低临床妊娠率及增加异位妊娠率。

Objective： To evaluate the safety of taking high-dose estradiol valerate （EzV） by patients in hormone replacement cycles for frozen-thawed embryo transfer （FET）. Methods： A retrospective study was conducted in 850 FET cycles in Xiangya Reproductive Medicine Center between January 2009 and June 2010. These cycle were divided into two groups, i.e. natural cycle group （499 cycles） and hormone replacement cycle group （351 cycles）. The pregnancy outcome and off- spring situation were compared between the two groups. Results： There were no significant differences between the natural cycle and hormone replacement cy- cles groups with regard to the rates of clinical pregnancy, ectopic pregnancy, abortion, prematurely deliv- ery, singleton delivery, multiple delivery, low-birth weighted singletons, birth defects, neonatal mortali- ty, delivery of male neonates and delivery of female neonates（P〉0.05）. If the dosage of E2V was more than 13 mg per day and total dosage of EzV was more than 201 mg before embryo transfer in hormone replacement cycle groups, clinical pregnancy rate was reduced and ectopic pregnancy rate was increased significantly （P〈0.05）. Conclusions： Administration of E2V properly during short time in hormone replacement cycles for FET was safe,but if E2V was more than certain dosage, clinical pregnancy rate was reduced and ectopic pregnancy rate was increased significantly.