人工周期-冻融胚胎移植结局的相关影响因素分析

Influencing factors of pregnancy outcomes of frozen-thawed cycles in patients with artificial hormone replacement therapy

目的探讨影响人工周期-冻融胚胎移植结局的相关因素。方法回顾性分析2019年1月至2020年12月在珠海市妇幼保健生殖中心进行第1周期IVF-ET助孕且行全胚冻存、第1次人工周期(HRT)准备内膜的冻融胚胎移植(FET)周期患者的临床资料。共纳入768个HRT-FET周期,按妊娠结局分为妊娠组(476周期)和未妊娠(292周期),分析影响妊娠结局的相关因素。结果妊娠组年龄显著低于未妊娠组[(30.13±3.95)岁vs.(33.39±3.86)岁](P<0.05),其他基础资料包括不孕年限、不孕因素、窦卵泡数、体质量指数(BMI)以及基础激素水平两组间均无统计学差异(P>0.05)。不同年龄、内膜准备启动日的子宫内膜厚度、戊酸雌二醇服用天数、转化日内膜厚度和移植不同期别的胚胎及胚胎数等因素下的妊娠率有显著性差异(P<0.05),而戊酸雌二醇服用方案、转化日血清雌二醇水平和转化内膜黄体酮使用方案等因素比较下的妊娠率无统计学差异(P>0.05)。多因素Logistic回归分析显示:年龄、内膜准备启动日的子宫内膜厚度、转化日内膜厚度和移植不同期别的胚胎及胚胎数是HRT-FET周期妊娠结局的相关影响因素(P<0.05)。结论在HRT-FET周期中,影响妊娠结局的主要因素包括年龄、内膜准备启动日子宫内膜厚度、转化日内膜厚度以及移植胚胎类型/数量;应重点监控所述影响因素,并根据不同年龄制定个体化方案。

Objective:To investigate the related factors affecting the clinical outcome of artificial hormone replacement therapy(HRT)-frozen-thawed(FET)cycles.Methods:The clinical data of patients(768 HRT-FET cycles)who underwent the first cycle of IVF-ET&whole embryo freezing and the first HRT for endometrial preparation-FET cycle in our center from January 2019 to December 2020 were retrospectively analyzed.According to the pregnancy outcome,they were divided into pregnancy group(476 cycles)and non-pregnancy group(292 cycles),and the related influencing factors of pregnancy outcome were analyzed.Results:The mean age in the pregnant group was significantly lower than that in the non-pregnant group[(30.13±3.95)vs.(33.39±3.86),P<0.05].There were no significant differences in infertility duration,infertility-associated factors,antral follicle count(AFC),BMI,basal FSH,basal hormone levels between two groups(P>0.05).There were significant differences in pregnancy outcomes under different factors such as age,endometrial thickness on the initial day of endometrial preparation,duration of estradiol valerate used,endometrial thickness on the endometrial transformation day,and type/number of embryos transferred(P<0.05),while there were no significant differences in pregnancy outcomes under different factors such as estradiol valerate of administration regimen,serum E 2 level on the endometrial transformation day and progesterone regimen used for endometrial transformation(P>0.05).Multivariate logistic regression analysis showed that age,endometrial thickness on the initial day of endometrial preparation,endometrial thickness on the endometrial transformation day,and the type/number of embryos transferred were the related influencing factors of pregnancy outcome in HRT-FET cycles(P<0.05).Conclusions:Female age,endometrial thickness on the initial day of endometrial preparation,endometrial thickness on the endometrial transformation day,and type/number of embryos transferred were the influencing factors of the pregnancy outcomes in HRT-FET cycles.These factors should be monitored,and the individualized protocol should be developed according to different ages.