不明原因反复种植失败患者4种冻融胚胎移植内膜准备方案的比较

Comparison of four endometrial preparation protocols for frozen-thawed embryos transfer in women with idiopathic repeated implantation failure

目的探讨不明原因反复种植失败(RIF)患者冻融胚胎移植(FET)周期4种不同内膜准备方案对助孕结局的影响。方法回顾性分析广东省妇幼保健院生殖健康与不孕症科2015年1月至2017年7月的RIF患者共381个FET周期的临床资料。按照子宫内膜准备方案的不同分成4组:自然排卵组(NC组,120个周期)、激素替代组(HRT组,195个周期)、垂体降调节后HRT组(GnRHa-HRT组,27个周期)和诱发排卵组(OI组,39个周期),比较4组患者的一般临床资料、周期特点和助孕结局。结果 4组中GnRHa-HRT组囊胚移植率最高,OI组卵裂期胚胎移植率最高,差异有统计学意义(P<0.05);各组间解冻前冻胚数、既往移植周期数、移植胚胎个数、移植日内膜厚度等比较,差异均无统计学意义(P>0.05)。移植卵裂期胚胎的妊娠结局比较:OI组、HRT组优胚率显著高于NC组(P<0.05);OI组的临床妊娠率、种植率及活产率较HRT组和NC组略高,但尚无显著性差异(P>0.05);3组患者的自然流产率比较无显著性差异(P>0.05)。移植囊胚期胚胎的妊娠结局比较:NC组、HRT组、GnRHa-HRT组和OI组4组的优胚率、临床妊娠率、种植率和活产率比较均无显著性差异(P>0.05);NC组、HRT组、GnRHa-HRT组的自然流产率略高于OI组,但尚无显著性差异(P>0.05)。结论 RIF患者采用此4种子宫内膜准备方案助孕的临床效果相当,NC和HRT方案可能更常应用于临床。

Objective ： To compare the effects of 4 different protocols of endometrium preparation for frozen-thawed embryos transfer （FET） in women with idiopathic repeated implantation failure （RIF）.Methods ： A total of 381 women undergone FET cycles with a history of recurrent implantation failure were enrolled in this retrospective study.According to the protocols of endometrial preparation,the patients were divided into four groups： nature cycle group （NC group, n =120）,hormone replacement group （HRT group, n =195）,HRT after down-regulation with GnRH agonist group （GnRHa-HRT group, n =27） and induced ovulation group （OI group, n =39）.The general data,cycle characteristics and clinical outcome were compared among the groups.Results ： The GnRHa-HRT group had the highest blastocyst transfer rate,and the OI group had the highest cleavage stage embryo transfer rate in the 4 groups;the difference was statistically significant （ P 〈0.05）.There were no significant differences in the numbers of frozen embryos,previous transplantation cycles,transplanted embryos,and endometrial thickness on transplantation day （ P 〉0.05）.Comparison the pregnancy outcomes of transplanted cleavage stage embryos,the good quality embryos rate in OI group and HRT group was significantly higher than that in NC group （ P 〈0.05）;the clinical pregnancy rate,implantation rate and live birth rate of the OI group were slightly higher than those of the HRT group and the NC group,but there was no significant difference （ P 〉0.05）.There was no significant difference in the abortion rate among the three groups （ P 〉0.05）.Comparison of pregnancy outcomes in transplanted blastocyst stage embryos,there were no significant differences in the good quality embryos rate,clinical pregnancy rate,implantation rate and live birth rate among the NC group,HRT group,GnRHa-HRT group and OI group （ P 〉0.05）.The abortion rate of the NC group,HRT group and GnRHa-HRT group was slightly higher than that of the OI group,but there was no significant difference （ P 〉0.05）.Conclusions ： The clinical outcomes of RIF patients with the four protocol of endometrial preparation are comparable,and NC and HRT protocols may be more commonly used in the clinic.