人工周期孕酮添加后子宫内膜厚度紧缩对冻融卵裂期胚胎移植后妊娠结局的影响

Effects of endometrial thickness compaction after progesterone addition on pregnancy outcomes after frozen-thawed cleavage embryo transfer cycles

目的研究人工周期孕酮给药后子宫内膜厚度紧缩对冻融卵裂期胚胎移植患者妊娠结局的影响。方法回顾性队列研究分析2015年7月1日至2021年3月1日期间于郑州大学第一附属医院生殖医学中心行首周期冻融卵裂期胚胎移植的1173例患者临床资料。将移植日子宫内膜厚度较孕酮添加日内膜厚度减少≥5%患者定为紧缩组(181例),余患者为未紧缩组(992例)。比较组间的临床妊娠率、持续妊娠率及活产率。结果紧缩组患者临床妊娠率[36.46%(66/181)]、持续妊娠率[34.25%(62/181)]均低于未紧缩组[48.99%(486/992),P=0.002;42.34%(420/992),P=0.043]。紧缩组活产率[32.66%(59/181)]略低于非紧缩组[39.62%(393/992)],但组间差异无统计学意义(P=0.075)。运用多因素回归模型矫正混杂因素,最终模型结果显示:孕酮添加后内膜厚度紧缩不利于患者获得临床妊娠(aOR=0.578,95%CI:0.412~0.811,P=0.002)以及持续妊娠(aOR=0.685,95%CI:0.485~0.967,P=0.031)。结论人工周期冻融卵裂期胚胎移植时,孕酮添加后子宫内膜厚度紧缩不利于患者获得以及维持妊娠。建议行解冻周期卵裂期胚胎移植的患者在孕酮添加后,适时监测子宫内膜厚度变化情况。

Objective To investigate the effect of endometrial thickness compaction after administration of progesterone on pregnancy outcomes of frozen-thawed cleavage embryo transfer patients.Methods In this retrospective cohort study,the clinical data of 1173 patients who received the first frozen-thawed cycle with cleavage embryo transfer in Center for Reproductive Medicine of the First Affiliated Hospital of Zhengzhou University from July 1,2015 to March 1,2021 were retrospectively analyzed.The patients with endometrial thickness decreased by≥5%on the day of transplantation compared with the day progesterone added was designated as the compaction group(181 cases),and the remaining patients were in the non-compacted group(992 cases).Clinical pregnancy rate,ongoing pregnancy rate,and live birth rate were compared between the two groups.Results The clinical pregnancy rate[36.46%(66/181)]and the ongoing pregnancy rate[34.25%(62/181)]of the patients in the compaction group were lower than those in the non-compacted group[48.99%(486/992),P=0.002;42.34%(420/992),P=0.043].In addition,the live birth rate in the compaction group[32.66%(59/181)]was lower than that in the non-compacted group[39.62%(393/992)],although not statistically significant(P=0.075).We used the multivariate regression model to correct confounding factors.The final model showed that endometrial compaction was inversely associated with clinical pregnancy(aOR=0.578,95%CI:0.412-0.811,P=0.002)and ongoing pregnancy(aOR=0.685,95%CI:0.485-0.967,P=0.031).Conclusion The compaction of endometrial thickness after the addition of progesterone is not conducive to the acquisition and maintenance of pregnancy in patients with cleavage embryo transfer.Based on the research's conclusions,we suggest that patients should timely detect the endometrial thickness after progesterone addition during the thaw cycle with cleavage embryo transferred.