三种不同内膜转化方案在冻融胚胎移植中的比较

Comparison of Three Different Endometrial Transformation Schemes in Frozen Embryo Transfer

目的探讨冻融胚胎移植(frozen embryo transfer,FET)周期中不同的内膜转化方案对妊娠结局的影响。方法选取在本院接受FET治疗的患者共325周期作为研究对象,所有患者均采用激素替代法(hormone replacement therapy,HRT)进行内膜增生期准备,当内膜厚度≥8 mm时使用孕激素进行内膜转化,按不同内膜转化方案分为三组,A组为口服地屈孕酮片(72周期),B组为肌肉注射恒定剂量黄体酮(172周期),C组为肌肉注射递增剂量黄体酮(81周期),所有患者于内膜转化第4天移植卵裂期胚胎,移植后改用口服地屈孕酮片联合黄体酮阴道制剂进行后续黄体支持。比较三组的妊娠结局。结果A组临床妊娠率及胚胎着床率显著性低于B组和C组(P<0.01),而B组与C组各指标比较差异无统计学意义(P>0.05)。结论冻融胚胎移植激素替代周期中,肌肉注射黄体酮进行内膜转化妊娠结局优于单纯口服地屈孕酮片。

Objective To investigate the effects of different endometrial transformation schemes on pregnancy outcomes in women offered frozen embryo transfer(FET).Methods A total of 325 cycles of patients undergone FET in our hospital were selected as the research objects.All patients were prepared for proliferative endometrium using hormone replacement therapy(HRT).When the thickness of endometrium was no less than 8 mm,endometrial transformation was performed with progesterone.According to different endometrial transformation schemes,patients were divided into three groups.The patients in group A were given oral dydrogesterone(72 cycles).The patients in group B were given intramuscular injection progesterone with constant dose(172 cycles).The patients in group C were given intramuscular injection progesterone with increasing dose(81 cycles).All patients were transplanted with cleavage embryos on the 4th day of endometrial transformation,and received oral dydrogesterone combined with vaginal progesterone preparing for subsequent luteal support from the day of transplantation.The pregnancy outcomes of the three groups were compared.Results The clinical pregnancy rate and embryo implantation rate of group A were significantly lower than group B and group C(P<0.01),while there were no significant differences between group B and group C(P>0.05).Conclusion In the hormone replacement cycle of frozen embryo transfer,the pregnancy outcome of endometrial transformation by using intramuscular injection progesterone was better than that of oral dydrogesterone alone.