超生理剂量雌激素方案对内膜薄患者子宫内膜厚度及FET妊娠结局的影响

Effect of supraphysiologic dose estrogen regimen on endometrial thickness and FET pregnancy outcome in patients with thin endometrium

目的通过对子宫内膜薄的患者使用超生理剂量雌激素治疗的冻融胚胎移植(FET)周期相关临床资料进行回顾性分析,探讨超生理剂量雌激素替代治疗方案后不同子宫内膜厚度(EMT)对FET妊娠结局的影响。方法回顾性分析2018年1月至2020年12月在广西玉林市妇幼保健院生殖中心对217例内膜薄患者(既往周期发现子宫内膜厚度<8 mm,或者本周期连续服用补佳乐8 d后仍EMT<8 mm者)行超生理剂量雌激素替代周期FET治疗的临床资料。将患者按内膜转化日EMT分为A组(EMT≥8 mm,n=105)和B组(EMT<8 mm,n=112);并以同期正常内膜厚度行自然周期FET治疗的患者为对照组(C组,n=107)。比较分析组间一般资料及FET结局。并且将B组患者根据妊娠结局及EMT进一步细化分组分析,并采用二元Logistic回归模型分析妊娠结局的相关影响因素。结果A、B、C三组患者的既往流产次数比较有统计学差异(P<0.05),B组患者既往流产次数的中位数最高;B组患者既往周期HCG日内膜最小厚度显著低于A组(P<0.05),其FET周期中雌激素使用天数、转化日雌二醇中位数均显著高于A组(P<0.05)。A、B、C三组患者的年龄、BMI、不孕类型、不孕年限、既往移植次数及本周期移植胚胎数、HCG阳性率、临床妊娠率、胚胎种植率、多胎妊娠率、流产率、异位妊娠率、持续妊娠/活产率比较均无显著性差异(P>0.05)。B组的亚组分析中:临床妊娠亚组年龄显著小于非临床妊娠亚组(P<0.05);6 mm<EMT<7 mm亚组本周期雌激素使用天数显著高于7 mm≤EMT<8 mm亚组(P<0.05),但亚组间妊娠结局无显著性差异(P>0.05);二元Logistic回归分析显示患者年龄为B组患者临床妊娠率的独立影响因素(OR=0.891,P<0.05)。结论既往流产次数多的患者子宫内膜变薄的几率升高,而通过增加雌激素的使用时间和使用剂量可以改善子宫内膜薄患者的妊娠结局;EMT≥6 mm时,EMT对患者的FET妊娠结局影响不大。

Objective:To investigate the effect of different endometrial thickness(EMT)on pregnancy outcome of frozen-thawed embryo transfer(FET)cycles after supraphysiologic dose estrogen therapy by retrospectively analyzing clinical data of FET cycles in patients with thin endometrium treated with supraphysiologic doses of estrogen.Methods:The clinical data of 217 patients with thin endometrium(EMT<8 mm in previous cycles or EMT<8 mm after 8 day of continuous supplementation with progynova in the current cycle)who underwent supraphysiologic dose of estrogen replacement therapy and FET cycle in the Reproductive Center of Guangxi Yulin Maternal and Child Health Hospital from January 2018 to December 2020 were retrospectively analyzed.The patients were divided into group A(EMT≥8 mm,n=105)and group B(EMT<8 mm,n=112)according to EMT on the endometrial transformation day.During the same period,the patients with normal endometrial thickness who underwent natural FET cycle were selected as the control group(group C,n=107).General information and FET outcomes were compared and analyzed among the groups.The patients in group B were further subdivided into groups for analysis according to pregnancy outcome and EMT.Binary logistic regression analysis was used to analyze the influencing factors related to pregnancy outcome.Results:The previous miscarriages times was significantly different among patients in groups A,B,and C(P<0.05),and the median of previous miscarriages times was the highest in group B.The minimum endometrial thickness on HCG day in previous cycles of patients in group B was significantly thinner than that of group A(P<0.05),and the days of estrogen used and median estradiol levels on transformation day in FET cycles were significantly higher than those in group A(P<0.05).There were no significant differences in age,BMI,infertility type,infertility years,number of previous transplants and number of embryos transferred in the current cycle,HCG positive rate,clinical pregnancy rate,embryo implantation rate,multiple pregnancy rate,miscarriage rate,ectopic pregnancy rate,and ongoing pregnancy/live birth rate among the groups A,B,and C(P>0.05).In the subgroup analysis of group B:the age of clinical pregnancy subgroup was significantly younger than that of the non-clinical pregnancy subgroup(P<0.05).The duration of estrogen used in 6 mm<EMT<7 mm subgroup was significantly longer than those in 7 mm≤EMT<8 mm subgroup in the current cycle(P<0.05),but there was no significant difference in pregnancy outcome among the subgroups(P>0.05).Binary logistic regression analysis showed that patient’age was an independent influence on clinical pregnancy rate in group B patients(OR=0.891,P<0.05).Conclusions:Patients with more previous abortions have an increased risk of endometrial thinning.The pregnancy outcomes in patients with thin endometrium can be improved by increasing the use time and dose of estrogen.Endometrial thickness has little effect on FET pregnancy outcomes in patients with EMT≥6 mm.