子宫内膜不典型增生或早期高分化子宫内膜癌患者保留生育功能治疗后体外受精-胚胎移植助孕妊娠结局分析

Outcomes of in vitro fertilization cycles following fertility-sparing treatment in atypical endometrial hyperplasia or stage ⅠA endometrial cancer

目的 探讨子宫内膜不典型增生(AEH)或早期高分化子宫内膜样腺癌(EC)患者保留生育功能治疗后行体外受精-胚胎移植(IVF-ET)助孕的临床情况和妊娠结局。方法 回顾性分析2012年1月至2020年12月于中山大学孙逸仙纪念医院生殖中心行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)及冻胚移植(FET)的AEH或早期高分化EC患者共57例的临床资料。结果 41例AEH患者共进行90个取卵周期,拮抗剂方案最多有28个,其次为微刺激方案,平均每周期获卵6个。AEH患者进行了22个新鲜胚胎移植周期和37个FET周期,累积妊娠率为29.0%,累积活产率为17.7%。16例早期高分化EC患者共进行24个取卵周期,拮抗剂方案最多有9个,其次为长方案,平均每周期获卵数为7个。EC患者共进行7个新鲜胚胎移植周期和15个FET周期,累积妊娠率为36.4%,累积活产率为31.8%。57例AEH或早期高分化EC患者进行了29个新鲜胚胎移植周期及52个FET周期,新鲜胚胎移植临床妊娠率为37.9%,活产率为31.0%,FET临床妊娠率为28.8%,活产率为17.3%,新鲜胚胎移植和FET间临床妊娠率、活产率的差异无统计学意义(P>0.05)。结论 接受保留生育功能治疗的AEH或早期高分化EC患者行IVF-ET助孕,可获得较满意的临床妊娠率和活产率,IVF-ET是AEH或早期高分化EC患者保守治疗后的很好助孕选择。

Objective To study the clinical status and pregnancy outcome of in vitro fertilization(IVF) cycles in patients with atypical endometrial hyperplasia(AEH)or stage Ⅰ A endometrial adenocarcinoma(EC) who underwent fertility-sparing conservative treatment.Methods Totally 57 patients who underwent IVF/ICSI-ET and FET in Sun Yat-sen Memorial Hospital Reproductive Center between January 2012 and December 2020 after fertility sparing treatment for AEH or early well differentiated EC were chosen for this study.Outcomes of IVF cycles were analyzed retrospectively.Results Totally 41 AEH patients underwent 90 IVF cycles,in which GnRH-antagonist protocol accounted for most(28),followed by mini-stimulation protocol(average 6 for each cycle).For AEH patients,22 fresh embryo transfer cycles and 37 frozen embryo transfer cycles were proceeded.The cumulative clinical pregnancy rate was 29.0%,and cumulative live birth rate was 17.7%.Totally 16 EC patients underwent 24 IVF cycles,in which GnRH-antagonist protocol accounted for most(9),followed by long protocol(average 7 for each cycle).For EC patients,7 fresh embryo transfer cycles and 15 frozen embryo transfer cycles were proceeded.The cumulative clinical pregnancy rate was 36.4%,and cumulative live birth rate was31.8%.These 57 AEH/EC patients had a total of 29 fresh embryo transfer cycles and 52 frozen embryo transfer cycles.The clinical pregnancy rate of fresh ET was 37.9%,and the live birth rate was 31.0%.The clinical pregnancy rate of frozen ET was 28.8% and the live birth rate was 17.3%.There was no statistical difference between fresh ET and frozen ET in clinical pregnancy rate or live birth rate(P0.05).Conclusion For young patients with AEH and stage ⅠA EC who receive fertility-sparing treatment,IVF-ET can result in satisfactory clinical pregnancy rate and live birth rate.IVF-ET is an optimal choice for these AEH/EC patients.