降调节人工周期冻融胚胎移植中不同孕酮转化时间结局分析

Analysis of Outcome of Frozen-Thawed Embryo Transfer using Down-Regulating Hormone Replacement Cycle in Different Endometrial Progesterone Preparation Time

目的比较降调节人工周期冻融胚胎移植中不同孕酮转化时间的的临床结局,探讨如何选择冻融胚胎移植的最佳时间。方法通过回顾性分析该生殖中心2018年1~12月本院行降调节人工周期准备内膜的冻融胚胎移植的448个周期,根据孕酮转化内膜时间分成4组:4-3组(孕酮转化子宫内膜4d后移植D3胚胎,n=59)、3-3组(孕酮转化子宫内膜3d后移植D3胚胎,n=27)、6-5组(孕酮转化子宫内膜6d后移植囊胚,n=178)和5-5组(孕酮转化子宫内膜5d后移植囊胚,n=184),分别比较D3天胚胎两种孕酮转化时间和D5天胚胎两种孕酮转化时间的基本情况和临床结局。结果4-3组和3-3组,6-5组和5-5组患者的一般情况比较,差异均无统计学意义(P>0.05)。4-3组、3-3组、6-5组和5-5组的生化妊娠率分别为59.32%(35/59)、59.26%(7/27)、71.35%(127/178)和71.20%(131/184),临床妊娠率分别为47.46%(28/59)、44.44%(12/27)、64.61%(115/178)和65.22%(120/184),异位妊娠率分别为0%(0/28)、0(0/12)、0.87(1/120)和0%(0/120),早期流产率分别为14.29%(4/28)、16.67%(2/12)、10.43%(12/115)和11.67%(14/120),四组的生化妊娠率、临床妊娠率、异位妊娠率、早期流产率相比较,差异均无统计学意义(P>0.05)。结论降调节人工周期准备内膜冻融胚胎移植中孕酮转化子宫内膜3d或4d移植第3d卵裂期胚胎,孕酮转化子宫内膜5d或6d移植囊胚均可获得满意的临床结局,临床工作中可以根据医院工作安排及患者的具体情况进行灵活调整。

Objective To investigate the best endometrial progesterone preparation time by comparing the clinical outcomes of different endometrial progesterone preparation time in the frozen-thawed embryo transfer using downregulating hormone replacement cycle.Methods A retrospective study was conducted of 448 patients who underwent frozen-thawed embryo transfer using down-regulating hormone replacement cycle fromJanuary 2018 to December2018 in our reproductive center.According to the endometrial progesterone preparation time,the patients were divided into four groups:4-3 group(4 days after endometrial progesterone preparation and transfer D3 embryo,n=59),3-3 group(3 days after endometrial progesterone preparation and transfer D4 embryo,n=27),6-5 groups(6 days after endometrial progesterone preparation and transfer D5 embryo,n=178)and 5-5 groups(5 days after endometrial progesterone preparation and transfer D5 embryo,n=184),the basic conditions and outcome were compared between group 4-3 and3-3,between group 6-5 and 5-5.Results There was no significant difference inbasic conditions between group 4-3 and 3-3,between group 6-5 and 5-5(P>0.05).The biochemical pregnancy rate of group 4-3,group 3-3,group 6-5 and group 5-5 was respectively 59.32%(35/59),59.26%(7/27),71.35%(127/178)and 71.20%(131/184),the clinical pregnancy rate was respectively 47.46%(28/59),44.44%(12/27),64.61%(115/178)and 65.22%(120/184),the ectopic pregnancy rate was respectively 0%(0/28),0(0/12),0.87(1/120)and 0%(0/120),respectively,the early abortion rate was respectively 14.29%(4/28),16.67%(2/12),10.43%(12/115)and 11.67%(14/120).There was also no significant difference in the rate of biochemical pregnancy,the rate of clinical pregnancy,the rate of ectopic pregnancy,the rate of natural miscarriage between group 4-3 and 3-3,between group 6-5 and 5-5(P>0.05).Conclusion The pregnancy outcomes weresimilar of frozen-thawed embryo transfer using down-regulating hormone replacement cycle by transferring D3 embryo or D5 blastocysts in different endometrial progesterone preparation time.We can adjusted flexibly according to the arrangement of hospital work and the specific situation of patients in the clinical work.