雌孕激素复合制剂对薄型子宫内膜行胚胎移植患者妊娠结局的影响

Effects of Estrogen and Progestin Combination Regimens on Pregnancy Outcome of Patients with Thin Endometrium Undergoing Embryo Transfer

目的探讨单纯口服雌二醇/雌二醇地屈孕酮与口服+阴道放置方案对行冻融胚胎移植薄型子宫内膜患者子宫内膜厚度及妊娠结局的影响。方法选取2015年3月—2017年3月收治的行冻融胚胎移植薄型子宫内膜患者160例,按治疗方法分为对照组和观察组,每组80例。对照组给予雌二醇/雌二醇地屈孕酮口服,观察组在对照组基础上加用阴道放置方案治疗。比较两组治疗前后子宫内膜厚度、容积、血流类型、用药剂量、转化日雌二醇水平、胚胎移植数、优质胚胎率、胚胎种植率、生化妊娠率及临床妊娠率。结果治疗后观察组子宫内膜厚度、容积及血流类型优于治疗前和对照组(P<0.05),用药剂量低于对照组,转化日雌二醇水平高于对照组(P<0.05),胚胎种植率、生化妊娠率和临床妊娠率均高于对照组(P<0.05)。观察组胚胎移植数、优质胚胎率与对照组无统计学差异(P>0.05)。结论雌二醇/雌二醇地屈孕酮口服+阴道放置方案用于行胚胎移植薄型子宫内膜患者可有效增加子宫内膜厚度,改善内膜容受性,减少药物用量,并有助于改善远期妊娠结局。

Objective To investigate effects of Estradiol/estradiol（ E2） Dydrogesterone by orally only and oral combined with vaginal placement on endometrial thickness and pregnancy outcome of patients with thin endometrium undergoing freeze thawing embryo transfer. Methods A total of 160 patients with thin endometrium undergoing embryo transfer admitted during March 2015 and March 2017 were divided into control group（ n = 80） and observation group（ n = 80） according to therapeutic methods. Control group was treated with Estradiol/estradiol Dydrogesterone by orally,while observation group was treated with Estradiol/estradiol Dydrogesterone by orally combined with vaginal placement.Endometrial thickness,endometrial volume and endometrial blood flow types,drug dosage and E2 levels at conversion day,number of embryos transfer,excellent embryo rate,embryo implantation rate,biochemical pregnancy rate and clinical pregnancy rate before and after treatment were compared in two groups. Results After treatment,in observation group,values of endometrial thickness,endometrial volume and endometrial blood flow types were significantly better than those before treatment and in control group（ P〈0. 05）; drug dosage was significantly lower,while E2 level at conversion day was significantly higher than those in control group（ P〈0. 05）,and values of embryo implantation rate,biochemical pregnancy rate and clinical pregnancy rate were significantly higher than those in control group（ P〈0. 05）.There were no significant differences in embryos transfer number and excellent embryo rate between two groups（ P〈0. 05）. Conclusion Estradiol/estradiol Dydrogesterone by orally combined with vaginal placement in treatment of patients with thin endometrium undergoing embryo transfer may efficiently increase endometrial thickness,improve endometrial receptivity and reduce drug dosage,and it is helpful to improve long-term outcome of pregnancy.