GnRHa降调节联合人工周期方案在反复植入失败患者中的应用研究

Application of GnRHa Descending Regulation Combined with Artificial Cycle in Patients with Recurrent Implantation Failure

目的探讨GnRHa降调节联合人工周期方案对反复植入失败后冻融胚胎移植妊娠结局的影响。方法对170例胚胎反复植入失败患者的解冻胚胎移植周期进行回顾性分析,根据内膜准备方案的不同分为两组。A组90例GnRHa降调节联合人工周期组,B组80例人工周期组,分别比较两组在黄体酮转化日内膜厚度、类型、血清雌二醇水平以及移植胚胎数、优胚数、优胚率、临床妊娠率、异位妊娠率、多胎率、早期流产率。结果 A组与B组患者在黄体酮转化日内膜的厚度、移植胚胎数、优质胚胎数、优质胚胎率、多胎率、异位妊娠率及早期流产率,差异无统计学意义(P>0.05);A组患者黄体酮转化日血清雌二醇水平低于B组,差异有统计学意义(P<0.05);两组患者内膜分型比较,差异无统计学意义(P>0.05),但降调节联合人工周期组患者A型内膜的比例较人工周期组高;A组患者的临床妊娠率为56.67%高于B组42.50%,差异有统计学意义(P<0.05)。结论 GnRHa降调节联合人工周期方案可改善反复植入失败后冻融胚胎移植的妊娠率。

Objective To investigate the effect of GnRHa descending regulation combined with artificial cycle on the outcome of frozen-thawed embryo transfer after recurrent implantation failure.Methods 170 cases of thawed embryo transfer were analyzed retrospectively.According to the different plans of endometrial preparation,in group A there were 90 cases of GnRHa descending regulation combined with artificial cycle group,and in group B there were 80 cases of artificial cycle.The diurnal thickness, type,serum estradiol level of the two groups and the number of transplanted embryos, optimal embryo number,optimal embryo rate,clinical pregnancy rate,ectopic pregnancy rate,multiple fetal rate and early abortion rate were compared respectively. Results There was no significant difference between group A and group B in the diurnal thickness of progesterone,the number of embryos transplanted,the number of high quality embryos,high quality embryo rate,multiple fetal rate,ectopic pregnancy rate and early abortion rate（ P〉0.05）.The serum estradiol level in group A was lower than that in group B on the day of progesterone conversion,the difference was statistically significant（P〈0.05）.There was no significant difference in endometrial classification between the two groups（ P〉0.05）,but the proportion of type A intima in patients with downregulation combined with artificial cycle group was higher than that of artificial cycle group.The clinical pregnancy rate of patients in group A was 56.67% higher than that in group B 42.50%,and the difference was statistically significant（P〈0.05）.Conclusion GnRHa combined with artificial cycle regimen can improve the pregnancy rate of frozen and thawed embryo transfer after recurrent implantation failure.