激素替代方案应用于子宫内膜生长不良患者冻胚移植内膜准备

Study on hormone replacement therapy for patients with poor endometrial growth to freezing-thawing embryo transfer

目的探讨子宫内膜生长不良患者行激素替代方案冻融胚胎移植周期中口服雌激素的不同时间及剂量对内膜厚度的影响。方法回顾性分析子宫内膜生长不良患者行激素替代方案冻胚移植97个周期。根据临床结局分为着床组与未着床组,分析胚胎种植结局与内膜厚度的关系。根据雌激素的用药时间、剂量分组,分析雌激素不同的用药时间、剂量对内膜厚度的影响。结果 (1)胚胎着床组与未着床组比较,雌激素应用时间、决定移植日内膜厚度无统计学差异,但着床组的内膜增厚值(决定移植日减去用雌激素12d内膜厚度值)明显大于未着床组,且差异有统计学意义(P<0.05)。(2)口服雌激素第19～21天组决定移植日内膜厚度以及内膜增厚值与第13～15天组、第16～18天组比较均明显增加,差异有统计学意义(P<0.05),与第22～24天组比较,差异无统计学意义(P>0.05)。(3)每日口服雌激素6mg组与9mg组决定移植日内膜厚度、内膜增厚值均无统计学差异(P>0.05)。结论内膜生长不良的患者在激素替代方案中内膜增厚值是影响冻胚移植结局的重要因素之一,雌激素用药时间在19～21d最有利于内膜生长及胚胎种植,但加大剂量对内膜生长无影响。

Objective To investigate the effects of hormone replacement therapy on endometrial thickness of different dosages and different duration of the patients with poor endometrial growth receiving oral estrogen in frozen- thawed embryo transfer cycles. Methods Retrospective analysis was performed on 97 frozen-thawed embryo transfer cycles of patients with poor endometrial growth treated with estrogen. Patients were divided into implantation group and non-implantation group based on elinical outcome to analyze the relation between embryo implantation outcome and endometrial thickness. Furthermore, the duration and dosage of estrogen were analyzed to detect the effects of different durations and dosages of estrogen on endometrial thickness. Results （ 1 ） It was observed that there was no statistical difference of the endometrial thickness in the estrogen application time and the day of deciding embryo transfer between the embryo implantation group and non-implantation group. However, the endometrial thickening value（ thickness value of the day of deciding embryo transfer minus the value of the 12th day of estrogen treatment）of implantation group was significantly higher than that of non-implantation group （ P 〈 0. 05 ）. （2） Compared with the 13-15 day group and 16-18 day group of the day of deciding embryo transfer, the endometrial thickness and endo/netrial thickening value of the 19-21 day group were significantly increased （P 〈 0. 05 ）, but there was no significance compared with the 22-24 day group（P 〉0. 05）. （3）There was no significant different on the endometrial thickness and endometrial thickening value between the groups of taking 6 mg estrogen and 9 mg estrogen on the day of deciding embryo transfer （ P 〉 0. 05 ）. Conclusions For patients with poor endometrial growth treated with estrogen for preparing endometria in freezing-thawing embryo transfer, the endometrial thickening value was one of the important factors for outcome of frozen-thawed embryo transfer. Taking the estrogen within 19-21 days was favorable for endometrial growth and embryo implantation, but increasing the dosage had no effect on endometrial growth.