薄型子宫内膜患者冻融胚胎移植周期17β雌二醇、人绝经期促性腺激素及他莫昔芬三种内膜准备方案临床结果比较

Comparison of clinical outcomes among 17β-estradiol,HMG and tamoxifen preparation for thin endometrium in frozen-thawed embryo transfer cycles

目的通过比较17β-雌二醇,人绝经期促性腺激素及他莫昔芬三种常用内膜准备方案的临床效果,拟探寻适合薄型子宫内膜患者的内膜准备方法。方法回顾性分析2015年1月至2016年10月于我中心行冻融胚胎移植的薄型子宫内膜患者427例,其中激素替代组(HRT组):123例;人绝经期促性腺激素(HMG)刺激组:155例;他莫昔芬(TAM)刺激组:149例。比较三组间冻融卵裂期胚胎移植周期内膜厚度、临床妊娠率、种植率、早期流产率、宫外孕率。结果HMG组[(8.1±1.6)mm]与TAM组[(8.2±1.6)mm]内膜显著厚于HRT组[(6.8±0.4)mm],(P<0.05)。临床妊娠率、胚胎种植率、早期流产率及宫外孕比率三组无统计学差异(P>0.05),但HMG组及TAM组的临床妊娠率、种植率略高于HRT组,早期流产率及宫外孕率略低于HRT组,以HMG组较为显著。HMG组的多卵泡发育比率显著高于TAM组(9.7%vs.0%,P<0.05)。结论薄型子宫内膜患者冻融胚胎移植,可尝试使用HMG、TAM刺激方案准备内膜,该方案可轻度提高胚胎种植率,降低宫外孕率,但OHSS高风险患者需慎用HMG方案。

Objective： To compare clinical outcomes among 17β-estradiol, HMG and tamoxifen preparation for thin endometrium in the frozen-thawed embryo transfer cycles in order to explore the effective endometrium preparation protocol for the patients with thin endometrium. Methods： The data of 427 patients with thin endometrium in the frozen-thawed embryo transfer cycles from January 2015 to October 2016 were retrospectively analyzed. The patients were given hormone replacement therapy （ HRT group, n= 123）, human menopausal gonadotropin （ HMG group, n= 155）, and tamoxifen （TAM group, n= 149） to prepare the endometrium respectively. The endometrial thickness, clinical pregnancy rate,implantation rate, abortion rate,and ectopic pregnancy rate were compared among the three groups. Results： The endometriumin HMG group [（8.1±1. 6）mm]and TAM group [（8.2±1.6）ram]were significantly thicker than that of HRT group[（6.8±0.4）mm]. There were no significant differences in the clinical pregnancy rate,implantation rate, abortion rate, and ectopic pregnancy rate among the three groups （P）0.05）. However, the clinical pregnancy rate and the implantation rate were slightly higher and the abortion rate and ectopic pregnancy rate were slightly lower in the HMG group and the TAM group than those in the HRT group. The multiple follicles development rate of the HMG group was significantly higher than that of the TAM group （9.7% vs. 0%,P〈0.05）. Conclusions： HMG and TAM,especially HMG,could slightly improve the embryo implantation rate, and reduce the ectopic pregnancy rate in patients with thin endometrium in FET cycles. The application of HMG in patients with high risk of OHSS should be prudent.