多次胚胎移植失败患者采用冻融胚胎移植3种内膜准备方案结局分析

Effects of different endometrium preparation for frozen-thawed embryos transfer in patients with repeated failure of embryo transfer

目的:探讨多次移植失败患者不同内膜准备方案对冻融胚胎移植结局的影响。方法:回顾分析多次胚胎移植失败者行冻融胚胎移植资料,其中采用自然周期45例(A组);采用激素替代周期33例(B组);采用降调节后激素替代周期40例(C组)。结果:3组对象的年龄、体重指数、不孕年限、解冻胚胎数、移植胚胎数、转化日雌二醇水平、转化日子宫内膜厚度、自然周期排卵前内膜厚度、早期流产率差异均无统计学意义(P>0.05);自然周期中排卵前内膜形态A组和B组优于C组,差异有统计学意义(P<0.05);B组、C组的胚胎种植率、临床妊娠率高于A组,差别有统计学意义(P<0.05),B组与C组之间差别无统计学意义(P>0.05);B组的移植优胚数高于C组(P<0.05),A组与C组、A组与B组差别均无统计学意义(P>0.05)。冻融胚胎移植周期中A组和B组转化日内膜形态优于C组,差异有统计学意义(P<0.05)。结论:对于多次移植失败者采用激素替代和降调节后激素替代子宫内膜准备法行冷冻胚胎解冻移植可获得较好的妊娠结局,对于子宫内膜形态欠佳者,建议行降调后激素替代方案。

Objective：To investigate the effects of different endometrium preparation for frozen thawed embryos transfer in patients with repeated failure of embryo transfer.Methods：Women with repeated failure of embryo transfer who underwent frozen-thawed embryos transfer were analyzed retrospectively,and were divided into three groups：45 cases in group A experienced natural cycle,33 cases in group B were given hormone replacement and 43 cases in group C received hormone replacement with down-regulation.Results：There were no significant differences among three groups in age,body mass index,infertility duration,the number of thawed embryo,the number of transplanted embryo,estradiol level and endometrial thickness on the day of endometrial transformation,the preovulatory endometrial thickness under natural cycle,and the early miscarriage rate （P both ＞0.05）.The preovulatory endometrial morphologies of group A and B were significantly superior as compared to group C （P both ＜0.05）.Embryo implantation rates and clinical pregnancy rates of group B and C were higher than those of group A,showing significant differences （P both ＜0.05）,but no significant difference was found between group B and C （P＞0.05）.Only the number of highquality post-implantation embryo in group B was higher as compared to group C （P＜0.05）,no significant difference was found otherwise.The endometrium types on the day of endometrial transformation of group A and B were significantly superior as compared to group C under natural cycle or frozen embryo transfer cycle （P both ＜0.05）.Conclusion：Using hormone replacement and hormone replacement after down-regulation to prepare the endometrium for frozen-thawed embryos transfer in patients with multiple transplant failure may obtain better pregnancy outcomes,and hormone replacement after down-regulation is recommended for those with poor endometrial morphology.