GnRH-a降调节-HRT内膜准备方案在PCOS首次FET移植失败人群中的应用

Application of GnRH agonist-HRT endometrial preparation program in PCOS population with first FET transplant failure

目的比较应用长效促性腺激素释放激素激动剂(GnRH-a)降调节-激素替代治疗(HRT)内膜准备方案(降调节-HRT)和HRT内膜准备方案对首次冻融胚胎移植(FET)移植失败的PCOS患者FET周期妊娠结局的影响。方法回顾性分析2016年1月至2019年5月河南省人民医院生殖中心就诊的首次FET失败的PCOS患者的临床资料(共553个周期),根据在子宫内膜准备过程中是否应用长效GnRH-a降调节,将553个周期分成2组:降调节-HRT组(A组,221个周期),HRT组(B组,332个周期),再根据胚胎情况分为不同亚组:降调节-HRT卵裂期组(A1组,101个周期),HRT卵裂期组(B1组,122个周期),降调节-HRT囊胚组(A2组,120个周期),HRT囊胚组(B2组,210个周期)。分别比较A组与B组、A1组与B1组、A2组与B2组患者的一般情况、实验室指标及妊娠结局。结果纳入的553个周期,总妊娠率为64.92%。B组的囊胚移植比例显著高于A组(P<0.05);两组的种植率、临床妊娠率、早期流产率及宫外孕率比较均无显著性差异(P>0.05)。A1与B1组的一般资料及实验室各指标比较均无显著性差异(P>0.05);A1组的临床妊娠率、胚胎种植率有高于B1组的趋势,早期流产率有低于B1组的趋势,但尚无显著性差异(P>0.05)。A2与B2组的一般资料及实验室指标比较均无显著性差异(P>0.05);两组的临床妊娠率、胚胎种植率、早期流产率及宫外孕率相近,组间比较均无显著性差异(P>0.05)。以临床妊娠为因变量,进行Logistic回归分析提示:卵裂期胚胎移植组:平均移植胚胎数、是否行GnRH-a降调节是临床妊娠的主要影响因素;囊胚移植组:平均移植胚胎数、平均移植优胚数是临床妊娠的主要影响因素。结论降调节-HRT在首次FET移植失败的PCOS患者行卵裂期胚胎移植时有改善其临床妊娠率、胚胎种植率的趋势,但尚无统计学意义。

Objective:To compare the effect of hormone replacement treatment(HRT)only and pretreatment of long-acting GnRH agonist(GnRH-a)down-regulation plus HRT cycle on the clinical outcomes of PCOS population with first frozen-thawed embryo transfer(FET)transplant failure.Methods:The data of 553 FET cycles of PCOS patients were retrospectively analyzed in Reproductive Center of Henan Provincial People’s Hospital from January 2016 to May 2019.According to whether the long-acting GnRH-a down regulation were used in the endometrial preparation process,553 cycles were divided into 2 groups:down regulation-HRT group(group A,221 cycles),HRT only group(group B,332 cycles).Then the cycles were divided into different subgroups according to embryonic conditions:down regulation-HRT cleavage stage group(group A1,101 cycles),HRT cleavage stage group(group B1,122 cycles),down-regulation-HRT blastocyst group(group A2,120 cycles),HRT blastocyst group(group B2,210 cycles).The general condition,laboratory indexes and clinical outcome of the patients were compared between group A and group B,A1 and B1,A2 and B2,respectively.Results:The total pregnancy rate of 553 cycles was 64.92%.The proportion of blastocyst transplantation in group B was significantly higher than that in group A(P<0.05).There was no significant difference in the implantation rate,clinical pregnancy rate,early abortion rate and ectopic pregnancy rate between the two groups(P>0.05).There was no significant difference in the general condition of and the laboratory indexes between group A1 and B1(P>0.05).The clinical pregnancy rate and embryo implantation rate of group A1 were higher,and the early abortion rate was lower than group B1,but there were no significant differences(P>0.05).There was no significant difference in the general condition and laboratory indexes between the group A2 and the group B2.There were no significant differences in the clinical pregnancy rate,embryo implantation rate and early abortion rate between the group A2 and B2(P>0.05).Logistic regression analysis of all factors with clinical pregnancy rate as a dependent variable showed that the average number of embryo transfer and whether GnRH-a down regulation performed were the main influencing factors of clinical pregnancy in cleavage stage embryo group;and the average number of embryos transplanted and the average number of good quality embryos transplanted were the main influencing factors of clinical pregnancy in blastocyst transplantation group.Conclusions:Down-regulation plus HRT has a tendency to improve the clinical pregnancy rate and embryo implantation rate in PCOS patients with a history of transplantation failure,but it is not significantly different.