不同促排卵方案在排卵障碍患者冻融胚胎移植内膜准备中的应用

Application of different ovulation induction schemes of endometrial preparation for frozen-thawed embryo transfer cycles in patients with ovulation disorder

目的比较不同促排卵方案在排卵障碍患者冻融胚胎移植(FET)内膜准备中的应用。方法回顾性分析行FET治疗的467例有排卵障碍患者的临床资料。依据内膜准备方案的不同分为四组:A组179例,采用来曲唑促排卵;B组64例,采用尿促性腺激素(HMG)促排卵;C组117例,采用来曲唑+HMG促排卵;D组107例,采用激素替代治疗(HRT)。比较四组患者临床结局。结果四组间转化日雌激素水平有统计学差异(P<0.01),但内膜厚度及形态无统计学差异(P>0.05)。C组的临床妊娠率和种植率分别为64.96%和47.53%,稍高于A组的56.24%和40.72%、B组的48.43%和33.91%、D组的56.07%和40.72%(P>0.05)。四组的流产率及异位妊娠率差异均无统计学意义(P>0.05)。结论对排卵障碍患者行FET时,来曲唑+HMG促排卵准备内膜方案与常规HRT方案及单纯来曲唑促排卵方案一样能获得良好的临床妊娠率,可作为促排卵准备内膜时的一种补充方案。

Objective To compare the application of different ovulation induction schemes of the endometrial preparation for frozen-thawed embryo transfer(FET) in the patients with ovulation disorder.Methods Data of 467 patients underwent FET were analyzed retrospectively.For the endometrial preparation,letrozole combined with hormone replacement scheme was taken in 179 cases(group A),urinary gonadotropin + hormone replacement ovulation induction regimen was taken in 64 cases(group B),letrozole + urinary gonadotropin + hormone replacement regimen was taken in 117 cases(group C) and hormone replacement cycle was taken in 107 cases(group D).The clinical outcomes were compared among the four groups.Results There was a significant difference in the estrogen level on the transformation day among the four groups(P<0.01),but the differences in the intima thickness and shape were not significantly different among the four groups(P>0.05).The clinical pregnancy rate and the implantation rate in group C were 64.96% and 47.53%,which were slightly higher than 56.24% and 40.72% in group A,48.43% and 33.91% in group B and 56.07% and 40.72% in group D(P>0.05).The abortion rate and ectopic pregnancy rate were not significantly different among the four groups(P>0.05).Conclusion In FET for the patients with ovulation disorder or irregular menstruation,the endometrial preparation regimen of letrozole + urinary gonadotropin may produce the same good clinical pregnancy rate as routine hormone replacement regimen or single letrozole regimen does,which can be used as a supplementary scheme of ovulation induction for the preparation of endometrium.