自然周期卵泡发育及是否排卵对解冻周期妊娠结局的影响

The Effect of Nature Cycle Follicular Development and Ovulation on the Outcome of Frozen Embryo Transfer Cycle

目的:探讨自然周期冻融胚胎移植(FET)影响助孕结局的有关因素。方法:回顾性分析2012年1月至2013年12月就诊于郑州大学第一附属医院生殖中心,采用自然周期行FET共1493例(1493周期)的临床资料,根据卵泡发育情况(以卵泡直径16.0 mm为界值)分为大卵泡组和小卵泡组,根据是否排卵分为排卵组和未排卵组。比较各组在LH峰日雌二醇(E_2)、孕酮(P)水平及其妊娠结局,以及移植卵裂期或囊胚期胚胎时不同分组的妊娠率和活产率。结果:1LH峰日小卵泡组的血清E_2值低于大卵泡组(P<0.01),而孕酮(P)值差异无统计学意义(P>0.05);卵泡排卵组与未排卵组E_2及P值的差异均无统计学意义(P>0.05)。2大小卵泡组的临床妊娠率及活产率比较,差异均无统计学意义(P>0.05);卵泡排卵组临床妊娠率及活产率均高于未排卵组(P<0.05)。3移植卵裂期胚胎排卵组的临床妊娠率及活产率均高于未排卵组(P<0.05);而移植囊胚期胚胎排卵组与未排卵组的临床妊娠率及活产率比较,差异均无统计学意义(P>0.05)。结论:自然周期FET时,内膜转化日卵泡大小对妊娠及产科结局无影响。卵泡排卵对妊娠结局有利,卵泡未排卵选择移植囊胚期胚胎可能有利于提高成功率。

Objective：To investigate the influencing factors of frozen thawed embryo transfer（ FET） in natural cycles. Methods ：The clinical data of 1493 patients undergoing FET in natural cycle in Reproductive Health Centre of 1 st Affiliated Hospital of Zhengzhou University from January 2012 to December 2013 were retrospectively ana- lyzed. All the cases were divided into two groups depend on the follicle developing level （diameter of the follicle 16. 0 mm） ：small-follicle group,and big-follicle group. Further comparisons were made on the outcomes of frozen embryo transfer cycle when the ovulation happened or not, along with embryos in cleavage stage or blastula stage. Results ：（1）In LH surge day,the serum estradiol level in the small-follicle group was significantly lower than that in the big-follicle group（ P 〈0. 01 ） ,while there was no significant difference on the serum progesterone level between the two groups （P 〉 0. 05）. There was no significant difference on both the serum estradiol and proges- terone level between the the ovulated group and the non-ovulated group （ P 〉 0.05）. （2）There was no statistical difference on clinical pregnancy rate and birth rate between the big-follicle group and small-follicle group （ P 〉 0.05） ,while the clinical pregnancy rate and birth rate of the ovulation group were statistically higher than the non-ovulated group（ P 〈0.05）. （3）The clinical pregnancy rate and live birth rate in the ovulated group transferring cleavage stage embryos were significantly higher than those in the non-ovulated group（ P 〈 0. 05）. Rut there was no significance difference on the clinical pregnancy rate and live birth rate between the two groups when blastula stage embryos were transferred（ P 〉 0.05）. Conclusions：The maximal diameters of follicular of FET in natural cycles have no effect on the pregnancy outcomes. While the ovulation is benefit to the pregnancy outcome, thenon-ovulated patient can choose blastula stage embryos to improve the success rate.