雌二醇-雌二醇地屈孕酮激素补充疗法在冻融胚胎移植中的临床研究

Clinic research of hormone supplement therapy of estradiol/estradiol and dydrogesterone in frozen-thawed embryo transfer

目的探讨雌二醇-雌二醇地屈孕酮激素补充疗法在冻融胚胎移植（FET）中的应用价值及影响激素补充结局的因素。方法行FET的妇女,从月经干净起（月经周期第4～7日）予雌二醇片（2 mg）每日1片阴道给药,月经周期第12日起B超监测子宫内膜,内膜厚度至少达到8 mm时,检测血清雌二醇,予黄体酮针剂60 mg,肌内注射,每日1次,雌二醇地屈孕酮复合片口服每次1片,每日2次。月经周期第15～19日行胚胎移植,检测血清雌二醇、孕酮。将完成的FET周期根据是否妊娠分为妊娠组和未妊娠组,比较两组的用药天数、内膜厚度和形态、生殖激素水平等。结果共纳入69例,完成72个FET周期,临床妊娠率为61%（44/72）,种植率为34.3%（57/166）。妊娠组内膜转换日及胚胎移植日血清雌二醇[（1 879.07±1 318.46）、（1 834.09±988.77）pg·mL^-1]显著高于未妊娠组[（1 850.21±755.27）、（1 358.82±695.65）pg·mL^-1]（P〈0.05）。两组内膜厚度无差异,但妊娠组内膜形态明显好于未妊娠组（P〈0.05）。结论雌二醇-雌二醇地屈孕酮片用于冻融胚胎移植的激素补充周期,方法简单可行,能获得较高的妊娠率,值得推广。内膜转换日及移植日血清雌二醇高者更易于妊娠,内膜形态是影响FET妊娠结局的重要因素。

AIM To explore the applied value of estradiol/estradiol and dydrogesterone in frozen-thawed embryo transfer （FET） and the factors influencing the hormone replacement outcome. METHODS The women enrolled in FET took estradiol 2 mg qd vaginally since the final day of menstruation （day 4 - 7）. When their endometrial thickness of uterus was ≥ 8 mm, serum estradiol was detected and progesterone injection （60 mg, im, qd） and a tablet of estradiol and dydrogesterone （po, bid） was given. The embryo transfer was performed on menstruation day 15 - 19 and serum estradiol and progesterone was detected. All completed FET cycles were divided into pregnant group and nonpregnant group according to its pregnancy outcome. The days of drug administration, endometrial thickness, pattern of uterus and estradiol level were compared between the two groups. RESULTS Totally 69 women were enrolled and 72 FET cycles were performed. The clinical pregnancy rate was 61% （44/72） , and the implantation rate was 34.3% （57/166）. The estradiol levels in the day of endometrial conversion and embryo transferin the pregnant group [（1 879.07 ±1 318.46）, （1 834.09 ± 988.77） pg· mL^-1] were significantly higher than those in the non-pregnant group [（1 850.21 ± 755.27）, （1358.82 ± 695.65） pg ·mL^-1], respectively （P 〈 0.05）. No significant difference was shown in endometrial thickness of uterus between the two groups, but the endometrial morphology in the pregnant group was better than that of the non- pregnant group （P 〈 0.05）. CONCLUSION The hormone supplement therapy of estradiol/estradiol and dydrogesterone in FET shows a high pregnancy rate, and it is simple, feasibility and worth of spreading. The level of estradiol and endometrial pattern are the important factors influencing the pregnancy outcome.