降调节雌孕激素方案在冻融胚胎移植中的临床应用

Clinical application of down-regulation of estrogen and progestogen program in frozen-thawed embryo transfer

目的 通过对满足特定条件的患者在冻融胚胎移植（FET）中使用降调节＋雌孕激素方案（降调节＋E-P方案）作为子宫内膜准备方法,并与自然周期方案、口服避孕药＋雌孕激素方案（OC＋E-P方案）的相关资料进行比较,探讨降调节＋E-P方案作为子宫内膜准备方法在FET中的临床应用价值。方法 收集2011年3月-2012年12月在该中心进行FET的639个周期的相关资料,回顾性分析降调节＋E-P方案与自然周期方案及OC＋E-P方案组患者年龄、体重指数、不孕年限、基础内分泌水平、决定移植日内膜厚度及形态、平均移植胚胎数、移植优质胚胎数、生化妊娠率、临床妊娠率及异位妊娠率等是否存在差异。结果 3种子宫内膜准备方案组患者年龄、体重指数、不孕年限、基础内分泌水平、移植胚胎数、移植优质胚胎数、优质胚胎率及决定移植日子宫内膜厚度比较,差异均无统计学意义（P〉0.05）;降调节＋E-P方案组患者生化妊娠率及临床妊娠率高于自然周期方案组和OC＋E-P方案组,3组生化妊娠率及临床妊娠率比较,差异均有统计学意义（P〈0.05）,而3组异位妊娠率比较,差异无统计学意义（P〉0.05）。结论 对于多次FET失败的患者,降调节雌孕激素方案与自然周期方案及OC＋E-P方案相比,可获得更好的临床妊娠率,降调节雌孕激素方案可作为多次FET失败患者的可行助孕方法。对于FET周期内膜准备方法的选择,应针对不同的患者采用不同的方案进行个体化治疗。

Objective：To use down-regulation combined with estrogen and progestogen program as endometrial preparation method for the patients with specific conditions in frozen-thawed embryo transfer（FET）,compare with related data of natural cycle program and oral contraceptive combined with estrogen and progestogen program,explore the clinical application value of down-regulation combined with estrogen and progestogen program as endometrial preparation method in FET.Methods：The related data of 639 FET cycles were collected in the center from March 2011 to December 2012,the differences of age,body mass index（BMI）,duration time of infertility,basic endocrine level,endometrial thickness and morphology on the day of determining transplantation,the average number of transferred embryos,the number of high quality embryos,biochemical pregnancy rate,clinical pregnancy rate,and ectopic pregnancy rate among down-regulation combined with estrogen and progestogen program,natural cycle program,and oral contraceptive combined with estrogen and progestogen program were analyzed retrospectively.Results：There was no statistically significant difference in age,BMI,duration time of infertility,basic endocrine level,the average number of transferred embryos,the number of high quality embryos,the rate of high quality embryos,and endometrial thickness on the day of determining transplantation among the three programs（P〈0.05）.The biochemical pregnancy rate and clinical pregnancy rate of down-regulation combined with estrogen and progestogen program were higher than those of the other two programs,there were statistically significant differences in biochemical pregnancy rate and clinical pregnancy rate among the three programs（P〈0.05）,but there was no statistically significant difference in ectopic pregnancy rate among the three programs（P〈0.05）.Conclusion：For patients who repeatedly fail in frozen-thawed embryo transfer,compared with natural cycle program and oral contraceptive combined with estrogen and progestogen program,down-regulation combined with estrogen and progestogen program can achieve higher clinical pregnancy rate,which can be used as a possible assisted reproductive method of patients who repeatedly fail in frozen-thawed embryo transfer.Different endometrial preparation methods in FET cycles should be selected individually targeting to different patients.