PCOS患者冻融胚胎移植周期中三种内膜准备方案妊娠结局及围产期结局比较

Comparison of clinical and perinatal outcomes of frozen-thawed embryo transfer cycles with three different endometrial preparation protocols in patients with polycystic ovary syndrome

目的探讨不同内膜准备方案对多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期妊娠结局及围产期结局的影响。方法回顾性分析2019年1月至2020年12月于西北妇女儿童医院生殖中心行FET治疗的928名PCOS患者(共1112个周期)的临床资料。根据不同内膜准备方案分为A组(激素替代方案,615个周期)、B组(GnRH-a降调节联合激素替代方案,461个周期)、C组(促排卵方案,36个周期)。比较3组患者的基本情况、妊娠结局及围产期结局。结果(1)三组间年龄、体质量指数(BMI)、移植胚胎数、移植囊胚占比、移植优胚占比均无统计学差异(P>0.05);B组及C组的转化日内膜厚度(分别为10.50 mm、10.90 mm)显著高于A组(10.20 mm)(P<0.05)。(2)B组的HCG阳性率、临床妊娠率显著高于A组(分别为81.13%vs.73.50%,72.90%vs.68.46%,P<0.05);C组的胚胎种植率(75.00%)显著高于A组(38.13%)及B组(31.74%)(P<0.05);三组间活产率无显著性差异(P>0.05),但C组的活产率(72.22%)有高于A、B组(分别为56.26%、56.18%)的趋势。(3)三组间单胎子代的早产率、出生体重、出生孕周均无统计学差异(P>0.05),但C组的单胎早产率(4.00%)较A、B组(分别为9.23%、9.33%)有降低趋势;C组仅有1个周期获得双胎,A组和B组间双胎子代的早产率、出生体重、出生孕周均无统计学差异(P>0.05),但均较各自的单胎子代早产率显著升高、出生体重显著下降、出生孕周显著缩短(P<0.01)。结论GnRH-a降调节联合激素替代方案和激素替代方案准备内膜在PCOS患者FET治疗中的妊娠结局及围产期结局相似;PCOS患者可能更加受益于促排卵方案准备内膜。

Objective:To compare the clinical outcomes and perinatal outcomes of frozen-thawed embryo transfer(FET) with three different endometrial preparation protocols in patients with polycystic ovary syndrome(PCOS)Methods:The clinical data of 928 PCOS patients(1 112 cycles) who received FET treatment in Assisted Reproductive Medicine Center of Northwest Women’s and Children’s Hospital from January 2019 to December 2020 were analyzed. According to endometrial preparation protocol, the cycles were divided into three groups: group A(hormone replacement group, n=615);group B(hormone replacement combined with pituitary down-regulation with GnRH-a group, n=461);group C(ovulation induction group, n=36). The basic characteristics and the pregnancy and perinatal outcomes were compared among the three groups.Results:There were no significant differences in age, BMI,numbers of embryo transferred, proportion of blastocysts transferred, proportion of high-quality embryo transferred among the three groups(P>0.05). Endometrial thickness on progesterone conversion day in group B(10.50 mm) and group C(10.90 mm) were significantly thicker than that in group A(10.20 mm)(P<0.05). The HCG positive rate and clinical pregnancy rate in group B were significantly higher than those in group A(81.13% vs. 73.50% and 72.90% vs. 68.46% respectively, P<0.05). The embryo implantation rate of group C(75.00%) was significantly higher than that of group A(38.13%) and group B(31.74%)(P<0.05). There was no significant difference in live birth rate among the three groups, but the live birth rate of group C(72.22%) was higher than that of group A and B(56.26% and 56.18% respectively)(P>0.05). There were no significant differences in preterm birth rate, neonatal birth weight and gestational weeks of singletons among the three groups(P>0.05),but the preterm birth rate in group C(4.00%) was lower than group B and group C(9.23% and 9.33% respectively, P>0.05). Group C only got twins in one cycle. There were no significant differences in preterm birth rate, neonatal birth weight and gestational weeks of twins between group A and group B(P>0.05). Either in group A or group B,higher preterm birth rate, lighter neonatal birth weight and shorter gestational weeks were found in twins than those in singletons(P<0.01).Conclusions:In FET treatment of PCOS patients, the clinical and perinatal outcomes are similar between hormone replacement combined with pituitary down-regulation preparation and hormone replacement preparation. However, PCOS patients may benefit from ovulation induced protocol.