剖宫产术后患者冻融胚胎移植周期的两种内膜准备方案的临床效果分析

Analysis of two different endometrial preparation protocols in frozen-thawed embryo transfer in patients after cesarean section

目的探讨两种不同子宫内膜准备方案对剖宫产术后患者冻融胚胎移植(FET)周期妊娠结局的影响。方法回顾性分析2017年1月1日至2021年12月31日于东莞市松山湖中心医院生殖医学中心行FET助孕的剖宫产术后患者的临床资料,共纳入406个FET周期。根据内膜准备方案分为人工周期组(HRT组,268个周期)和降调节后人工周期组(GnRH-a+HRT组,138个周期),比较两组患者的一般情况及妊娠结局;每组患者所移植胚胎按发育阶段的不同分为卵裂期胚胎和囊胚亚组,进一步分析不同发育阶段胚胎移植在两组患者中的妊娠结局。结果两组患者间取卵年龄、不孕年限、移植周期数、体质量指数(BMI)、多囊卵巢综合征(PCOS)患者占比、移植日子宫内膜厚度、移植胚胎数、优胚数比较均无显著性差异(P>0.05)。GnRH-a+HRT组的胚胎种植率、临床妊娠率和活产率均显著高于HRT组(P<0.05),其余观察指标均无统计学差异(P>0.05)。按所移植胚胎的发育阶段亚组比较,GnRH-a+HRT组移植卵裂期胚胎患者的活产率显著高于HRT组(P<0.05),GnRH-a+HRT组移植囊胚患者的胚胎种植率、临床妊娠率和活产率均显著高于HRT组(P<0.05),其余观察指标均无统计学差异(P>0.05)。结论与HRT方案相比,GnRH-a+HRT方案在提高剖宫产术后患者FET周期妊娠结局方面更有优势。

Objective:To explore the effect of two different endometrial preparation protocols on the pregnancy outcome of frozen-thawed embryo transfer in patients after cesarean section.Methods:The clinical data of 406 cycles in patients who underwent the frozen-thawed embryo transfer(FET)after cesarean section in the Reproductive Medicine Center of Dongguan Songshan Lake Central Hospital from January 1,2017 to December 31,2021 were retrospectively analyzed.According to the endometrial preparation protocol,the patients were divided into the artificial cycle group(HRT,268 cycles)and the artificial cycle after down-regulation with GnRH agonist group(GnRH-a+HRT,138 cycles).The general conditions and pregnancy outcomes of the two groups of patients were compared.The embryos transferred to each group of patients were divided into cleavage stage embryos and blastocyst subgroups according to different embryo developmental stages.The patients of each group were divided into cleavage stage embryos subgroup and blastocyst subgroup according to the different developmental stages of the transferred embryos.The pregnancy outcomes of embryo transfer at different developmental stages were further analyzed between the two subgroups.Results:There were no significant differences in the female age at oocyte retrieval,the fertility years,the number of transfer cycles,the body mass index(BMI),the proportion of patients with polycystic ovary syndrome(PCOS),the thickness of endometrium on the day of transplantation,the number of embryos transferred and the number of excellent embryos between the two groups(P>0.05).The embryo implantation rate,clinical pregnancy rate and live birth rate in GnRH-a+HRT group were significantly higher than those in HRT group(P<0.05).There was no statistical difference in other observation indicators(P>0.05).The subgroup comparison according to of the developmental stages of the transferred embryos,the live birth rate of the patients with cleavage embryo transfer in GnRH-a+HRT group was significantly higher than that of those in the HRT group(P<0.05).The embryo implantation rate,clinical pregnancy rate,and live birth rate of the patients with blastocyst transfer in the GnRH-a+HRT group were significantly higher than those in the HRT group(P<0.05).There was no statistical difference in other observation indicators(P>0.05).Conclusions:Compared with HRT protocol,GnRH-a+HRT protocol has more advantages in improving the pregnancy outcomes of FET in patients after cesarean section.