反复种植失败的子宫内膜异位症患者冻融胚胎移植结局的影响因素

An analysis on factors influencing the outcome of frozen-thawed embryo transfer in endometriosis patients with repeated implantation failure

目的探讨改善反复种植失败(RIF)的子宫内膜异位症(EMS)患者冻融胚胎移植结局的有效措施。方法回顾性分析2016-2020年共81周期RIF的内异症不孕患者的临床资料,通过logistic回归分析影响临床妊娠结局的因素,并根据内膜准备方案分为自然周期(NC)组、诱发排卵(OI)组、激素替代(HRT)组及降调HRT组,比较各组患者的基线资料和助孕结局。结果“移植胚胎数”和“移植胚胎类型”是临床妊娠结局的影响因素(P<0.05)。非优质胚胎来源的囊胚种植率高于卵裂期优质胚胎。HRT组的平均移植胚胎数较NC组明显增加(P<0.05),临床妊娠率及胚胎种植率高于NC组及降调HRT组,但差异无统计学意义(P>0.05);各组间的多胎率、早期流产率及异位妊娠率等比较差异无统计学意义(P>0.05)。根据移植胚胎类型不同,分别比较三组间的优胚率及临床妊娠率,差异无统计学意义(P>0.05)。IVF/ICSI前是否经过手术治疗对临床妊娠结局影响差异无统计学意义(P>0.05)。结论RIF的EMS患者不同内膜准备方案临床妊娠结局相当,必要时可适当增加移植胚胎数目或移植囊胚以提高临床妊娠率。

Objective To explore the effective ways for improving the outcome of frozen-thawed embryo transfer(TET)in endometriosis patients with repeated implantation failure(RIF).Methods The clinical data on endometriosis patients with RIF following total 81 TET cycles from January 2016 to December 2020 were retrospectively analyzed.According to different protocols of endometrial preparation,the patients were divided into natural cycle(NC)group,ovulation induction(OI)group,hormone-replacement therapy(HRT)group,and down-regulated HRT group.The baseline information and outcomes of assisted conception were compared among these groups.The factors influencing clinical pregnancy outcome were analyzed by multivariate logistic regression.Results The number and type of transferred embryos were the factors affecting the pregnancy outcomes(P<0.05).The implantation rate of blastocysts from non-high quality embryos was significantly higher than that of high-quality cleavage embryos(P<0.05).The mean number of transferred embryos was significantly higher in HRT group than NC group(P<0.05).The rates of clinical pregnancy and implantation were higher in HRT group than NC group and down-regulated HRT group,but there were no significant differences(P>0.05).The rates of multiple pregnacy,early abortion,and ectopic pregnancy did not differ significantly among the four groups(P>0.05).According to differences in the type of transferred embryos,there were no statistical differences in the rates of high-quality embryo and clinical pregnancy among the three groups(P>0.05).No statistical differences were found in the impact of presence or absence of surgical treatment prior to IVF/ICSI on the clinical pregnancy outcomes(P>0.05).Conclusions The endometriosis patients with RIF receiving differentendometrial protocols were comparable in their pregnancy outcomes.For improving the clinical pregnancy rate,the number of transplanted embryos can appropriately be increased or the blastocyst should be transplanted if necessary.