冻融胚胎移植HRT周期中雌激素用药策略对妊娠结局的影响

Effect of estrogen administration strategy on pregnancy outcome in HRT cycle of frozen thawed embryo transfer

目的探讨冻融胚胎移植周期中黄体酮转化日血清雌二醇水平、雌激素用药时长及总用药剂量分别在不同用药方案中对妊娠结局的影响。方法选取我院2014年9月至2018年12月冻融胚胎移植周期中使用HRT方案的周期820个,分别按用药方案不同分组:口服补佳乐组为A组419人,口服芬吗通组为B组136人,口服芬吗通联合阴道用药为C组265人。比较三组的雌激素用药时长、用药总量及转化日血清雌激素水平与临床妊娠结局的相关分析。结果雌激素用药总量与妊娠率的相关分析拟合度为8.7%,D-W值1.347,两者之间存在序列相关关系;雌激素用药时长与妊娠率的相关分析拟合度为10.5%,D-W值1.107,两者之间存在序列相关关系;雌二醇水平与妊娠率的相关分析的拟合度为4.1%,D-W值1.69,两者不存在序列相关。结论 HRT周期方案中保证一定的用药时长与雌激素用药总量即可以达到一定的妊娠率,不建议以转化日雌二醇水平作为指标条件来用于确定黄体酮的转化时机。

Objective:To investigate the effect of estradiol level,estrogen duration and total estrogen dosage on pregnancy outcome in frozen-thawed embryo transfer(FET)cycles.Methods:From September 2014 to December 2018,820 cycles of frozen-thawed embryo transfer using HRT regimen were selected in our hospital.They were divided into different groups according to different medication regimens:419 patients in Group A were treated with oral estradiol valerate tablets,136 patients in Group B were treated with oral Femoston and 265 patients in Group C were treated with fenmotone combined with vaginal medication.The correlations between estrogen duration,total estrogen dosage and serum estrogen level on the day of conversion and clinical pregnancy outcome were analyzed.Results:The correlation between estrogen use and pregnancy rate was 8.7%,and D-W was 1.347;The goodness of fit between estrogen duration and pregnancy rate was 10.5%,and D-W was 1.107;The correlation between estradiol level and pregnancy rate was 4.1%,and D-W was 1.69;The results showed that there was a sequence correlation between the total estrogen dosage and the duration of estrogen administration and the pregnancy rate,but no correlation between the estradiol level on the day of conversion and the pregnancy rate.Conclusion:So a certain pregnancy rate could be achieved by ensuring a certain duration of treatment and total estrogen use in HRT cycle regimen.It is not recommended to use conversion day estradiol level as an index condition to determine the conversion time of progesterone.