冻融周期中不同子宫内膜转化时间移植囊胚的妊娠结局分析

Analysis of pregnancy outcome of blastocyst transplantation with different endometrial transformation time in frozen⁃thawed cycle

目的比较冻融周期中不同子宫内膜转化时间移植囊胚的临床结局,探讨冻融移植周期中囊胚移植策略。方法回顾性分析2021年5月至2021年12月于邢台不孕不育专科医院生殖医学中心采用激素替代周期或降调节⁃激素替代周期准备子宫内膜进行囊胚冻融移植245个周期的妊娠结局。根据孕酮转化子宫内膜时间及移植不同发育天数囊胚的情况分为4组:D6⁃5组(100个周期,孕酮转化子宫内膜第6天移植第5天囊胚),D7⁃5组(48个周期,孕酮转化子宫内膜第7天移植第5天囊胚),D6⁃6组(71个周期,孕酮转化子宫内膜第6天移植第6天囊胚),D7⁃6组(26个周期,孕酮转化子宫内膜第7天移植第6天囊胚),比较各组的临床妊娠率、种植率、异位妊娠率、流产率、活产率。结果4组患者的年龄、不孕年限、不孕类型、治疗方式、体质量指数、AMH、不孕因素、移植日内膜厚度、胚胎移植个数、胚胎评价比较,差异均无统计学意义(P>0.05);与D6⁃5组相比,D7⁃5组的胚胎着床率、临床妊娠率、活产率均有升高趋势;与D6⁃6组相比,D7⁃6组的胚胎着床率、临床妊娠率、活产率均有下降趋势;第6天囊胚与第5天囊胚相比,无论在转化子宫内膜的第6天还是第7天移植,妊娠率均有下降趋势。结论冻融周期中子宫内膜转化D6、D7移植囊胚妊娠结局无明显差异,临床工作可灵活安排,但是优选第5天囊胚进行移植可获得较满意的结果。

Objective To compare the clinical outcomes of blastocyst transfer with different endometrial transformation time in the frozen⁃thawed cycle,and to explore the blastocyst transfer strategy in the frozen⁃thawed cycle.Methods From May 2021 to December 2021,the pregnancy outcomes of 245 cycles of blastocyst freeze⁃thawed transplantation using hormone replacement cycle or downregulation hormone replacement cycle for preparing endometrium in the Center of Reproductive Medicine of Xingtai Infertility Hospital were analyzed retrospectively.According to the time of transforming endometrium with progesterone and the condition of transplanting blastocysts on different development days,they were divided into four groups:D6⁃5 group(100 cycles,blastocysts on the 6th day of transforming endometrium with progesterone transplanted on the 5th day),D7⁃5 group(48 cycles,blastocysts on the 7th day of transforming endometrium with progesterone transplanted on the 5th day),D6⁃6 group(71 cycles,blastocysts on the 6th day of transforming endometrium with progesterone transplanted on the 6th day),and D7⁃6 group(26 cycles,blastocysts on the 7th day of transforming endometrium with progesterone transplanted on the 6th day).Compared the clinical pregnancy rate,implantation rate,ectopic pregnancy rate,miscarriage rate,and live birth rate of each group.Results There was no significant difference in age,infertility years,infertility types,treatment methods,body mass index,AMH,infertility factors,endometrial thickness on the day of transplantation,number of embryo transfers and embryo evaluation between the 4 groups(P>0.05).Compared with D6⁃5 group,the embryo implantation rate,clinical pregnancy rate and live birth rate in D7⁃5 group had an increasing trend.Compared with D6⁃6 group,the embryo implantation rate,clinical pregnancy rate and live birth rate in D7⁃6 group had a downward trend.Compared with the blastocyst on the 5th day,the pregnancy rate of the blastocyst on the 6th day and the 7th day after endometrial transformation showed a downward trend.Conclusion There is no significant difference in pregnancy outcome between D6 and D7 blastocysts transplanted with endometrial transformation during the freeze⁃thaw cycle,and the clinical work can be arranged flexibly,but the optimal transfer of the 5th day blastocysts can obtain satisfactory results.