序贯移植联合GnRH-a对不明原因反复种植失败患者冻胚周期妊娠结局的影响

Effect of sequential transfer combined with GnRH-a on pregnancy outcome for patients with unexplained repeated implantation failure in frozen embryo cycles

目的探讨序贯移植联合促性腺激素释放激素激动剂(GnRH-a)对不明原因反复种植失败(RIF)患者冻胚周期妊娠结局的影响。方法回顾性选取2017年1月至2023年1月在杭州市妇产科医院行激素替代周期冻胚移植助孕的不明原因RIF患者314例,根据移植胚胎情况以及是否使用GnRH-a分为4组,即2枚早期胚胎组(2_(D3)组)66例、2枚囊胚组(2D_(5/6)组)52例、序贯移植组(序贯组)100例、序贯移植联合GnRH-a组(序贯+GnRH-a组)96例。比较4组患者冻胚移植周期参数、妊娠结局等,采用单因素及多因素logistic回归分析不明原因RIF患者临床妊娠的影响因素。结果除激素替代方案比较差异有统计学意义(P=0.037)外,4组患者雌二醇、孕酮、内膜厚度、移植优胚数、囊胚来源等其余冻胚移植周期参数比较,差异均无统计学意义(均P>0.05)。序贯+GnRH-a组临床妊娠率高于其余各组(均P<0.025),且序贯组高于2_(D3)组(P<0.025);序贯+GnRH-a组种植率、活产率均高于序贯组和2_(D3)组(均P<0.025),且序贯组均高于2_(D3)组(均P<0.025);序贯+GnRH-a组多胎妊娠率低于2D_(5/6)组但高于2_(D3)组(均P<0.025),且序贯组低于2D_(5/6)组(P<0.025);4组患者早期流产率比较差异无统计学意义(P=0.921)。相较于序贯、2D_(5/6)、2_(D3),序贯+GnRH-a是不明原因RIF患者临床妊娠的独立保护因素(OR=0.659、0.585、0.315,均P<0.05)。结论序贯移植联合GnRH-a有助于改善不明原因RIF患者冻胚周期的妊娠结局。

Objective To explore the effect of sequential transfer combined with gonadotropin releasing hormoneagonist(GnRH-a)on pregnancy outcome for patients with unexplained repeated implantation failure(RIF)in frozen embryo cycles.Methods A retrospective analysis was performed on 314 patients who were admitted to Hangzhou Women's Hospital from January 2017 to January 2023 underwent hormone replacement cycle frozen embryo transfer and diagnosed as unexplained RIF.According to the status of embryo transfer and whether GnRH-a was used,the patients were divided into 2 early embryo groups(2_(D3)group),2 blastocyst groups(2D_(5/6)group),sequential transfer group(sequential group),and sequential transfer combined with GnRH-a group(sequential+GnRH-a group).The parameters of frozen embryo transfer cycle and pregnancy outcome of the 4 groups were compared,and the influencing factors of clinical pregnancy in patients with unexplained RIF were analyzed by univariate and multivariate logistic regression.Results There was no significant difference in frozen embryo transfer parameters,such as estradiol,progesterone,thickness of the endometrium,number of embryos transferred and source of blastocyst among the 4 groups(all P>0.05),except for the difference in hormone replacement regimen(P=0.037).The clinical pregnancy rate in sequential+GnRH-a group was significantly higher than those in other groups(all P<0.025),and that in sequential group was higher than that in 2_(D3)group(P<0.025).The implantation rate and live birth rate of sequential+GnRH-a group were higher than those of sequential group and 2_(D3)group(all P<0.025),and those of sequential group were higher than those of 2_(D3)group(all P<0.025).The multiple pregnancy rate in the sequential+GnRH-a group was lower than that in the 2D_(5/6)group but higher than that in the 2_(D3)group(both P<0.025),and that in sequential group was lower than that in 2D_(5/6)group(P<0.025).There was no significant difference in the early abortion rate among the 4 groups(P=0.921).Compared with sequential,2D_(5/6),2_(D3),sequential+GnRH-a was an independent protective factor for clinical pregnancy in patients with unexplained RIF(OR=0.659,0.585,0.315,all P<0.05).Conclusion Sequential transfer combined with GnRH-a can improve the pregnancy outcome of frozen embryo cycle in patients with unexplained RIF.