两种内膜准备方法对多囊卵巢综合征患者妊娠结局的影响

Effects of two endometrial preparation schemes on the pregnancy outcome of patients with polycystic ovary syndrome

目的探讨冻融胚胎移植术(FET)中采用不同方法准备内膜对多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者妊娠结局的影响.方法回顾性分析2016年1月至2017年12月期间于兰州大学第一医院生殖医学专科医院行FET术获临床妊娠的205例PCOS患者的资料.根据不同的内膜准备方法进行分组,其中常规激素替代组70例,促性腺激素释放激素激动剂(GnRH-a)降调节后激素替代组135例.分析比较两组患者的妊娠丢失率(早期流产率+晚期流产率+异位妊娠率)、早产率、活产率、低出生体质量儿率及妊娠并发症的情况.结果常规激素替代组的妊娠丢失率[25.7%(18/70)]高于GnRH-a降调节后激素替代组[13.3%(18/135)](P=0.027),其中前者的早期流产率[21.4%(15/70)]高于后者[8.1%(11/135)],差异有统计学意义(P=0.007);常规激素替代组的活产率[74.3%(52/70)]低于GnRH-a降调节后激素替代组[86.7%(117/135)],差异有统计学意义(P=0.027).患者的平均年龄、体质量指数(BMI)、移植日子宫内膜厚度、移植胚胎数、胚胎种植率组间比较差异均无统计学意义(P>0.05);常规激素替代组的移植优质胚胎率[34.2%(52/152)]有高于降调节后激素替代组[25.6%(80/312)]的趋势,但差异无统计学意义(P>0.05).患者晚期流产率、异位妊娠率、早产率、多胎率、妊娠并发症率组间比较差异均无统计学意义(P>0.05),每组各有1例新生儿死亡.结论与常规激素替代法相比,应用GnRH-a降调节后激素替代方法准备内膜的PCOS患者在临床妊娠后更有可能获得更好的妊娠结局.

Objective To compare the pregnancy outcomes of clinical pregnancy patients with polycystic ovary syndrome (PCOS) who underwent frozen-thawed embryo transfer (FET) using different methods to prepare endometrium. Methods The data of 205 clinical pregnancy patients with PCOS who were treated in Reproductive Medicine Special Hospital of the 1st Hospital of Lanzhou University during the period from January 2016 to December 2017 were retrospectively analyzed. The patients were grouped according to different methods of endometrial preparation, including routine hormone replacement group (n=70) and gonadotropin-releasing hormone agonist (GnRH-a) downregulation hormone replacement group (n=135). The rates of pregnancy loss (containing early miscarriage, late miscarriage and ectopic pregnancy), premature delivery, live birth, low birth weight infant and pregnancy complications were compared between the two groups. Results Pregnancy loss rate in routine hormone replacement group [25.7%(18/70)] was higher than that in GnRH-a downregulation hormone replacement group [13.3%(18/135)](P=0.027). The early miscarriage rate of the former [21.4%(15/70)] was higher than that of the latter [8.1%(11/135)](P=0.007). The live birth rate [74.3%(52/70)] in the routine hormone replacement group was lower than that in the GnRH-a downregulation group [86.7%(117/135)](P=0.027). No significant differences were found between the two groups in mean age, body mass index (BMI), endometrial thickness on transplant day, number of transplanted embryos, and embryo implantation rate (P>0.05). The rate of good-quality embryo transplantation in routine hormone replacement group [34.2%(52/152)] was higher than that in downregulation hormone replacement group [25.6%(80/312)], but there was no significant difference (P>0.05). There were no significant differences in the rates of late miscarriage, ectopic pregnancy, premature delivery, multiple pregnancy, and pregnancy complication between the two groups (P>0.05). One neonatal death happened in each group. Conclusion It’s more likely to achieve good pregnancy outcomes when patients with PCOS prepared endometrium with GnRH-a downregulation hormone replacement comparing with the routine hormone replacement.