自然周期冻融胚胎移植内膜准备中使用不同药物诱发排卵对妊娠结局的影响

Pregnancy Outcomes of Different Hormonal Induced Cycles in Women with Frozen-thawed Embryo Transfer

目的:比较采用自然周期冻融胚胎移植内膜准备过程中自然排卵与人绒毛膜促性腺激素(h CG)诱发排卵及促性腺激素释放激素激动剂(Gn RHa)诱发排卵的不同临床结局。方法:回顾性分析湖南省郴州市第一人民医院生殖医学中心2011年10月—2013年10月采用自然周期准备子宫内膜的273例冻融胚胎移植周期。根据是否使用诱发排卵药物及药物的种类分为3组:A组为自然排卵组(n=181);B组为h CG诱发排卵组(n=47);C组为Gn RHa诱发排卵组(n=45)。比较3组患者的临床资料和妊娠结局。结果:13组年龄、移植日子宫内膜厚度、移植胚胎数、移植优胚率等比较差异无统计学意义(P>0.05)。2A组临床妊娠率(56.4%)高于C组(33.3%,P<0.01),而A组临床妊娠率与B组比较差异无统计学意义(P>0.016 7)。结论:在自然周期冻融胚胎移植的内膜准备过程中,使用h CG诱发排卵对妊娠结局无不良影响,而使用Gn RHa诱发排卵则可能影响其临床结局。

Objective： To compare the pregnancy outcomes of spontaneous natural cycle versus human chorionic gonadotropin（h CG） and gonadotropic releasing hormone agonist（Gn RHa） induced cycle in those women with frozen-thawed embryo transfer. Methods：The 273 natural cycles of the frozen-thawed embryo transfer were retrospectively analyzed in our reproductive center from October,2011 to October,2013. Those cycles were divided into three groups according to ovulation inducing methods：group A,spontaneous ovulation（n=181）;group B,triggering with h CG（n=47）;group C,triggering with Gn RHa（n=45）. The pregnancy outcome and other clinical parameters were compared among three groups. Results： 1 There were not significantly differences in age, endometrial thickness on the day of transfer, embryonic number of transfer and the rate of high-quality embryo among three groups（P 〉0.05）. 2 The clinical pregnancy rate in group A（56.4%） was significantly higher than that in group C（33.3%,P〈0.01）,while there was not significantly difference in this rate between group A and group B（P〉0.016 7）. Conclusions：The adverse effect of h CG induced ovulation on the pregnancy outcome was not significant in the frozen-thawed embryo transfer, while Gn RHa induced ovulation may affect the pregnancy outcome of the frozen-thawed embryo transfer.