来曲唑联合HMG准备子宫内膜在冻融胚胎移植中的应用

Letrozole combined with HMG for endometrial preparation in FET cycles

目的探讨来曲唑(LE)联合人绝经期促性腺激素(HMG)准备子宫内膜在冻融胚胎移植(FET)中应用的有效性及安全性。方法回顾性分析2013年7月至2015年6月在本中心行FET助孕周期的临床资料。根据内膜准备方案的不同进行分组:采用LE联合HMG方案进行内膜准备的3 480个周期为LE组;自然周期的940个周期为自然周期组;采用人工周期的1 495个周期为人工周期组。比较3组患者的一般情况、HCG日/内膜转化日的内膜厚度及激素水平、移植胚胎情况、周期取消率、临床妊娠率及流产率等。结果各组间患者的一般情况比较均无显著性差异(P>0.05)。自然周期组的周期取消率(2.23%)显著高于其他两组(0.66%、0.74%)(P<0.05)。LE组HCG日成熟卵泡直径[(21.95±2.30)mm]显著大于自然周期组[(18.57±0.92)mm],LH水平[(16.89±11.01)U/L]则显著低于自然周期组[(33.44±24.51)U/L](P<0.05)。LE组的临床妊娠率(61.85%)及活产率(49.46%)显著高于自然周期组(54.95%和42.76%)和人工周期组(53.17%和39.35%),流产率(9.97%)则显著低于自然周期组(19.21%)和人工周期组(11.91%)(P<0.05)。结论 LE联合HMG方案用于FET前内膜准备,其周期取消率及流产率低,临床妊娠率及活产率高,安全有效,值得临床推广。

Objective： To explore the efficacy and safety of letrozole （LE） combined with HMG for endometrial preparation in frozen-thawed embryo transfer （FET） cycles. Methods： The data of FET cycles with different protocols for endometrial preparation in our center from July 2013 to June 2015 were retrospectively analyzed. There were 3 480 cycles using LE combined with HMG （LE group）, 940 natural cycles （nature group） and ] 495 artificial hormone replacement therapy （HRT） cycles （HRT group）. Endometrium thickness and hormone levels on transforming day or HCG day were compared among the three different groups. Besides, embryo evaluation and cycle cancellation rate, FET outcomes （pregnancy rate, implantation rate and miscarriage rate） were also compared. Results： The cycle cancelation rate in the natural group （2.23 %） was significantly higher than that in the other two groups （0. 66% ,0.74% respectively） （P〈0.05）. The mature follicle diameter on HCG day in LE group [（21.95±2.30） mm] were significantly larger than that in the natural group [（18.57±0.92） mm],but LH levels [（16.89±11.01） U/L] in LE group were significantly lower than those in natural group [（33. 44±24. 51） U/L] （P〈0.05）. The clinical pregnancy rate （61.85%） and live birth rate （49.46%） in LE group were significantly higher than the natural group （54.95%, 42. 76%） and HRT group （53.17%,39.35%） （P〈0. 05）. The miscarriage rate in LE group （9.97%） was significantly lower than that in the natural group （19.21%） and the HRT group （11.91%） （P〈0. 05）. Conclusions： LE combined with HMG for endometrial preparation in FET cycle is effective and safe. Its cancelation rate and miscarriage rate are lower,clinical pregnancy rate and live birth rate is higher. It is worthy of clinical promotion.