GnRH-a降调节后内膜准备方案对PCOS患者冻融胚胎移植结局的影响

Influence of long-acting GnRH agonist on outcome of frozen thawed embryo transfer cycle in patients with polycystic ovarian syndrome

目的比较应用长效促性腺激素释放激素激动剂(GnRH-a)降调节后人工周期和单纯人工周期这两种方法准备子宫内膜对PCOS患者冻融胚胎移植(FET)妊娠结局的影响。方法回顾性分析2013年6月至2015年6月在吉林大学第二医院生殖中心就诊的PCOS患者的临床资料,根据在子宫内膜准备过程中是否应用长效GnRH-a降调节将152个周期分成两组:降调节后人工周期(A组,76周期),单纯人工周期(B组,76周期)。比较两组患者的临床指标和结局。结果两组患者的年龄、不孕年限、体重指数(BMI)、基础LH、E_2以及睾酮(T)水平、空腹血糖、空腹胰岛素水平、总胆固醇、甘油三脂等均无统计学差异(P>0.05);两组患者的移植周期数、移植日子宫内膜厚度、黄体酮转化日平均孕酮水平及移植胚胎数均无统计学差异(P>0.05),但A组黄体酮转化日的LH[(5.34±4.50)U/L]、E_2[(145.26±57.50)pmol/L]及T[(2.15±0.45)nmol/L]水平均显著低于B组[分别为LH(10.14±0.88)U/L、E_2(179.71±89.89)pmol/L、T(2.53±0.28)nmol/L](P<0.05);A组的胚胎着床率和临床妊娠率均显著高于B组[分别为45.06%vs.32.20%和61.54%vs.42.11%)](P<0.05)。结论应用长效GnRH-a降调节后人工周期建内膜方案可能改善PCOS患者FET结局。

Objective： To investigate the effect of hormone replacement treatment（HRT） with pretreatment of long-acting GnRH agonist （GnRH-a） on the clinical outcomes of frozen-thawed embryo transfer（FET） cycles in patients with polycystic ovarian syndrome（PCOS）. Methods： The data of 152 FET cycles of PCOS patients were retrospectively analyzed in the Reproductive Center, Department of Gynecology ＆ Obstetrics, Second Affiliated Hospital of Jilin University from June 2013 to June 2015. The patients were divided into group A with GnRH-a ＆ HRT treatment（n=76） and group B only with HRT treatment（n= 76）. The age, duration of infertility,body mass index（BMI）, basis LH, E2, T, fasting blood-glucose, fasting insulin, total cholesterol, triglyceride, number of frozen embryo implantation cycles, thickness of endometrium on FET day, embryo transfer rate, embryo implantation rate, clinical pregnancy rate, early abortion rate and eetopic pregnancy rate were compared between the two groups. Results： There was no significant differences in patients＇ age,duration of infertility,BMI,basis levels of LH, E2, T, fasting blood-glucose, fasting insulin, total cholesterol, triglyceride, cycle number, endometrial thickness on FET day,progesterone level and number of embryos transfer on progesterone conversion day （P〉0.05）. However,the LH levels [（5. 34±4. 50） vs. （10.14±0.88）U/L],E2 levels [（145.26±57. 50） vs. （179.71±89.89）pmol/L] and T levels [（（2.15±0. 45） vs. （2.53±0.28）nmol/L] were significantly lower than those in group B（P〈0.05）. The embryo implantation rate（45.06% vs. 32.20%） and clinical pregnancy rate（61.54% vs. 42.11%） were significantly higher than those in group B（P〈0.05）. Conclusions： Artificial HRT cycle for endometrial preparation after application of long-acting GnRHa for pituitary suppression can improve the outcome of FET for PCOS patients.