Artificial Cycle with or without a Depot Gonadotropin-releasing Hormone Agonist for Frozen-thawed Embryo Transfer： An Assessment of Infertility Type that Is Most Suitable

The clinical outcomes of five groups of infertility patients receiving frozen- thawed, cleavage-stage embryo transfers with exogenous hormone protocols with or without a depot gonadotropin-releasing hormone （GnRH） agonist were assessed. A retrospective cohort analysis was performed on 1003 cycles undergoing frozen-thawed, cleavage-stage embryo transfers from January 1, 2012 to June 31, 2015 in the Reproductive Medicine Center of Wuhan General Hospital of Guangzhou Military Region. Based on the infertility etiologies of the patients, the 1003 cycles were divided into five groups： tubal infertility, polycystic ovary syndrome （PCOS）, endometriosis, male infertility, and unexplained infertility. The main outcome was the live birth rate. Two groups were set up based on the intervention： group A was given a GnRH agonist with exogenous estrogen and progesterone, and group B （control group） was given exogenous estrogen and progesterone only. The results showed that the baseline serum hormone levels and basic characteristics of the patients were not significantly different between groups A and B. The live birth rates in groups A and B were 41.67% and 29.29%, respectively （P〈0.05）. The live birth rates in patients with PCOS in groups A and B were 56.25% and 30.61%, respectively （P〈0.05）. The clinical pregnancy, implantation and on-going pregnancy rates showed the same trends as the live birth rates between groups A and B. The ectopic pregnancy rate was significantly lower in group A than in group B. We concluded that the live birth rate was higher and other clinical outcomes were more satisfactory with GnRH agonist co- treatment than without GnRH agonist co-treatment for frozen-thawed embryo transfer. The GnRH agonist combined with exogenous estrogen and progesterone worked for all types of infertility tested, especially for women with PCOS.

Improvement of Live Birth Rate Following Frozen-Thawed Blastocyst Transfer by Combination of Prednisolone Administration and Stimulation of Endometrium Embryo Transfer

The endometrial condition is a significant factor for successful pregnancy. To regulate endometrial function in fertility treatment, prednisolone (PSL) is administered for suppression of increased natural killer cells and stimulation of endometrium embryo transfer (SEET) to enhance communication between embryo and maternal tissues. We attempted to improve the endometrial condition by PSL administration and SEET during frozen–thawed blastocyst transfer (FBT). Patients took PSL (5 mg) 3 times daily for 3 days after ovulation during the FBT cycle. To analyse effects of PSL combined with SEET, we determined rates of chemical pregnancy, clinical pregnancy, foetal heart movement (FHM) and live birth. Rates of chemical pregnancy, clinical pregnancy and FHM were significantly higher in the PSL(+)/SEET(+) (57.7%, 50.0% and 46.2%, respectively) and PSL(+)/SEET(-) (53.3%, 46.7% and 46.7%, respectively) groups than in the PSL(-)/SEET(+) (30.3%, 18.2% and 18.2%, respectively) and PSL(-)/SEET(-) (22.4%, 22.4% and 18.4%;P = 0.0043, 0.0081 and 0.0055, respectively) groups. The live birth rate was significantly higher in the PSL(+)/SEET(+) group than in the PSL(+)/SEET(-), PSL(-)/SEET(+) and PSL(-)/SEET(-) groups (42.3%, 26.7%, 18.2% and 12.2%, respectively;P = 0.0237). PSL combined with SEET may be a useful adjunct to assisted reproductive technology in women who repeatedly fail to conceive by infertility treatment.

Influence of Blastocysts Morphological Score on Pregnancy Outcomes in Frozen-thawed Blastocyst Transfers: a Retrospective Study of 741 Cycles

The influence of inner cell mass （ICM） and trophectoderm （TE） score on pregnancy out- comes in frozen-thawed blastocyst transfer cycles was analyzed. A retrospective analysis of 741 cycles of frozen-thawed blastosysts transfer was performed. All cycles were divided into four groups based on the number and morphological score of blastocysts： S-ICM B/TE B group （n=91）, the single blastocyst transfer oflCM B and TE B; D-ICM B/TE B group （n=579）, double blastocysts transfer oflCM B/TE B; D-1CM B/TE C group （n=35）, double blastocysts transfer of ICM B/TE C; and D-ICM C/TE B group （n=36）, double blastocysts transfer ofTE B/ICM C. The pregnancy outcomes were compared among the four groups. As compared with D-ICM B/TE C group, the clinical pregnancy rate, implantation rate and multiple pregnancy rate were increased in D-ICM B/TE B group （74.96% vs. 57.14%, 57.43% vs. 37.14%, and .48.62% vs. 25%, respectively, P〈0.05 for all）. Clinical pregnancy rate and implantation rate in D-ICM B/TE B group were also higher than in D-ICM C/TE B group （74.96% vs. 50%, and 57.43% vs. 33.33%, both P〈0.05）. Multivariable Logistic regression analysis indicated that ICM score was a better predictive parameter for clinical pregnancy （OR=3.05, CI 1.70-5.46, P〈0.001）, while the trophectoderm score was a better one for early abortion （OR=0.074, CI 0.03-0.19, P〈0.001）. Clinical pregnancy rate and multiple pregnancy rate in S-ICM B/TE B group were significantly lower than those in D-ICM B/TE B group （46.15% vs. 74.96%, and 2.38% vs. 48.62%, both P〈0.05）, but there was no si~,,niflcant difference in the implantation rate between the two groups. It was suggested that the higher score of ICM and TE may be indicative of the better pregnancy outcomes. The ICM score is a better predictor of clinical pregnancy than TE, while TE score is a better one in predicting early abortion. Sin- gle ICM B/TE B blastocyst transfer in frozen-thawed cycles can also get satisfactory pregnancy out- comes.

Analysis of Factors Influencing Pregnancy Rate in Frozenthawed Embryo Transfer

Objective To analyse factors influencing the outcome of frozen-thawed embryo transfer （FET）. Method A retrospective analysis was performed in our center on 129 thawing cycles from March 2001 to April 2003. The related parameters were compared between conceived and non-conceived cycles. Results There were totally 129 clinical pregnancies in these transfers （pregnancy rate： 27.1%）. Frozen-thawed embryos were transferred to natural cycles and CC cycling and hormone replacement treatment had equal success. Groups of IVF and ICSI did not differ significantly in pregnancy rates （P〉0.05）. The pregnancy rates for one, two, three and four pre-embryos transfer were 0, 20.0%,44.1% and 75.0%, respectively （P〈0.05）. There were statistical differences between pregnancy group or non- pregnancy group in the endometrial thickness, CES, CES/No. of embryo. A higher pregnancy rate was observed in embryo transfers which had at least one 4-cell grade I embryo （d 2）（P〈0.01）. Conclusions The most important factors influencing the implantation rate and pregnancy rate of frozen-thawed embryo transfer are age, endometrium thickness, and the number, morphology and growth rate of transferred frozen embryos of women participants.

冻融优质单囊胚移植失败后重复周期胚胎移植策略的探讨

目的探讨冻融优质单囊胚移植失败后重复周期的胚胎移植策略。方法回顾性分析2018年7月至2022年10月在我中心进行冻融优质单囊胚移植后重复周期治疗患者的临床资料,共887个周期。根据患者年龄不同分为<35岁组(568个周期)和≥35岁组(319个周期),每组又根据胚胎移植情况分为5个亚组:单优囊组(移植冻融优质单囊胚)、双优囊组(移植冻融优质双囊胚)、优+非优囊组(移植冻融优质+非优质双囊胚)、双非优囊组(移植冻融非优质双囊胚)及双优卵裂组(移植冻融双卵裂胚)。比较各组患者的基础资料及妊娠结局。结果<35岁组中单优囊组、双优囊组、优+非优囊组、双非优囊组及双优卵裂组患者的年龄、基础FSH、移植日内膜厚度等基础资料比较均无显著性差异(P>0.05);单优囊组的临床妊娠率显著低于其他4组(60.41%vs.77.08%、72.73%、69.74%、70.83%,P<0.05),活产率亦显著低于其他4组(49.80%vs.68.75%、61.82%、59.21%、61.11%,P<0.05),双优卵裂组的多胎妊娠率显著高于单优囊组(38.24%vs.1.35%,P<0.05),但显著低于双优囊组(67.57%)、优+非优囊组(57.50%)及双非优囊组(56.60%)(P<0.05)。≥35岁组中各亚组的基础资料亦无显著性差异(P>0.05);各亚组间的临床妊娠率、活产率、流产率比较均无显著性差异(P>0.05),但单优囊组的多胎妊娠率显著低于其他4组(0.00%vs.33.33%、29.17%、20.59%、15.00%,P<0.05)。结论对于接受冻融优质单囊胚移植后行重复周期治疗的不孕患者,冻融胚胎移植策略的选择需要综合权衡。年龄≥35岁的患者,5种胚胎移植策略获得的临床结局相近,可以根据患者实际情况进行选择;而年龄<35岁的患者,在没有条件进行冻融优质单囊胚移植时,也可以考虑冻融优质双卵裂胚移植策略,但其后续多胎妊娠率风险较高,仍需要关注。

催眠训练对冻融胚胎移植患者身心状态的影响研究

目的研究催眠训练对冻融胚胎移植(FET)患者焦虑、抑郁等身心状态的影响,探索心理干预在辅助生殖领域应用的可行性。方法195例FET患者,在周期治疗中各环节点均常规给予健康宣教和心理护理。入组患者移植日术前增加一堂约20 min的催眠训练课。比较所有FET患者催眠训练前后贝克抑郁量表(BDI)、贝克焦虑量表(BAI)评分,BDI分度,BAI分度,脉率,选择负性情绪词汇情况,选择正性情绪词汇情况。结果FET患者BDI评分由催眠训练前的(3.58±4.87)分下降至催眠训练后的(1.03±2.43)分,BAI评分由催眠训练前的(8.02±8.04)分下降至催眠训练后的(2.59±4.41)分(P<0.05)。催眠训练后,BDI分度为0~10分的患者占比97.95%与催眠训练前的91.28%相比较显著升高,11~45分的患者占比2.05%与催眠训练前的8.72%相比显著降低(P<0.05)。FET患者催眠训练后BAI分度为0~10分占比85.13%相较于催眠训练前的44.62%升高,11~20分的占比12.82%较催眠训练前的49.74%下降(P<0.05);催眠训练后21~30分、31~50分的占比也呈下降趋势,但由于样本量少,与催眠训练前相比无明显差异(P>0.05)。FET患者催眠训练后的脉率为(75.5±7.8)次/min较催眠训练前的(79.7±8.1)次/min显著下降,有明显差异(P<0.05)。催眠训练后选择负性情绪词汇人次明显减少,其中担心、紧张、焦虑、紧绷、心慌、烦躁、害怕、泄气、悲伤选择率分别为21.03%、9.23%、2.56%、8.21%、0、4.10%、6.67%、1.54%、0,均低于催眠训练前的76.41%、62.56%、34.87%、28.72%、23.59%、21.03%、17.95%、6.15%、5.13%,有明显差异(P<0.05);由于选择崩溃的人次较少,催眠训练前后数据无明显差异(P>0.05)。所列10个正性词汇中,催眠训练后有放松、平静、舒适、踏实、信心、温暖、安全、愉快选择率80.51%、78.97%、40.51%、36.41%、32.31%、22.05%、12.82%、21.03%,与催眠训练前的13.33%、26.15%、7.69%、6.67%、19.49%、6.67%、5.13%、12.82%比较,有明显差异(P<0.05);兴趣、希望选择率分别为1.54%、30.77%,与与催眠训练前的0、30.26%比较,无明显差异(P>0.05)。结论催眠训练能显著降低FET患者的焦虑抑郁水平,减少患者负性情绪,增加正性情绪,提升患者的身体、心理舒适度和就医感受,具有良好的应用推广价值。

多囊卵巢综合征患者冻融胚胎移植周期妊娠结局的影响因素分析

目的探讨多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期妊娠结局的影响因素。方法回顾性分析882个FET周期PCOS患者的资料,根据患者的妊娠结局分为未着床组(A组)、流产组(B1组)和活产组(B2组)。比较这三组患者的临床资料和实验室指标,并使用有序Logistic回归分析冻融胚胎移植后妊娠结局的影响因素。再按照获取优质囊胚数的百分位数(0~3、4~6、7~10、≥11个)将患者分为C1、C2、C3、C4组,比较不同优质囊胚数组患者的临床资料及实验室相关指标。结果882个PCOS患者移植周期的临床妊娠率71.09%(627/882),活产率61.68%(544/882),流产率13.24%(83/627)。单因素分析显示,在A、B1和B2这三组的比较中,体质量指数(BMI)、不孕类型、注射人绒毛膜促性腺激素(hCG)日雌二醇(E_(2))水平、获卵数和优质囊胚数之间存在显著差异(P<0.05)。对五项差异指标进行进一步多元Logistic回归分析显示,BMI(OR=1.046,95%CI:1.001~1.093,P=0.044)和有既往妊娠史(OR=1.417,95%CI:1.030~1.950,P=0.032)是PCOS患者成功妊娠的独立危险因素。A组与B2组比较:OR=0.920,95%CI:0.880~0.962,P=0.000;B1组与B2组比较:OR=0.923,95%CI:0.862~0.988,P=0.022;而优质囊胚数增多则是妊娠成功的独立保护因素。在优质囊胚数C1-C4这四组之间比较中,与其他三组相比,C4组的促性腺激素(Gn)总量最低,获卵数最多(P<0.05)。C4组的BMI、促卵泡生成素(FSH)和极低密度脂蛋白(vLDL)水平较C1组低,黄体生成素与促卵泡生成素(LH/FSH)比值比C1组高(P<0.05)。C4组与C3组相比,空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)值较低,与C2和C3组相比,高密度脂蛋白胆固醇(HDL-C)和载脂蛋白A1(ApoA1)水平较高(P<0.05)。结论BMI、既往妊娠史和优质囊胚数是预测PCOS患者FET周期妊娠结局的独立因素。优质囊胚数更多的患者在FET周期中具有更高的临床妊娠率。

益气血补肝肾方对胚胎反复种植失败患者冻融胚胎移植周期妊娠结局的影响

目的探讨益气血补肝肾方对胚胎反复种植失败(RIF)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月至2023年6月在广州市第一人民医院生殖健康与不孕症专科行FET的120例RIF患者临床资料。患者月经周期规律,年龄25~35岁,按照FET前是否接受益气血补肝肾方治疗分为对照组和研究组,各60例;另选取同时期57例既往无胚胎移植史的FET患者作为正常组。3组均采用激素替代(HRT)方案准备内膜。研究组在准备内膜前先给予益气血补肝肾方3个月经周期(经后增殖方:煎成20 ml,制成颗粒剂10 g,1包/d,早晚分2次服用,月经干净后开始服用至排卵期;促黄体方:煎成20 ml,制成颗粒剂10 g,1包/d,早晚分2次服用,自排卵后开始服用至月经第1~3天停药)。比较3组患者内膜转化日子宫内膜厚度、血流搏动指数(PI)、动脉阻力指数(RI)、胚胎着床率和临床妊娠率。统计学方法采用单因素方差分析和χ^(2)检验。结果正常组和研究组子宫内膜厚度均高于对照组,PI、RI均低于对照组,3组子宫内膜厚度、PI、RI比较[(10.33±2.27)mm比(10.24±1.81)mm比(9.03±1.41)mm、(1.86±0.52)比(1.96±0.21)比(1.97±0.20)、(0.56±0.10)比(0.58±0.90)比(0.62±0.09)],差异均有统计学意义(F=8.40、6.08、6.89,均P<0.05)。正常组和研究组胚胎着床率、临床妊娠率均高于对照组,3组比较差异均有统计学意义[43.9%(43/98)比38.8%(40/103)比25.2%(26/103)、57.9%(33/57)比55.0%(33/60)比35.0%(21/60);χ^(2)=8.18、7.37,均P<0.05]。结论益气血补肝肾方可通过降低子宫内膜血流阻力指数和搏动指数,增加子宫内膜厚度,提高胚胎着床率和临床妊娠率,改善RIF患者FET周期妊娠结局。

黄体酮软胶囊不同给药方案用于激素替代冻融胚胎移植黄体支持的临床结局比较

目的比较黄体酮软胶囊不同给药方案进行激素替代冻融胚胎移植中黄体支持的临床疗效。方法对2019年1月至2021年12月期间在中南大学湘雅医院生殖中心行激素替代冻融胚胎移植的3845例患者临床数据进行回顾性分析,纳入的所有患者黄体支持均采用阴道用黄体酮软胶囊联合口服地屈孕酮治疗,根据阴道用黄体酮软胶囊不同用法将其划分为两组:A组每次使用200 mg,每日3次,共1858个周期;B组每次使用300 mg,每日2次,共1987个周期,评估两组的临床治疗效果。结果两组患者在年龄、不孕年限、体质量指数(BMI)、转化日子宫内膜厚度、转化日雌激素(E_(2))水平、转化日孕激素(P)水平、移植优胚占比等方面比较均无显著差异(P>0.05)。A、B两组患者的活产率分别是34.71%(645/1858)和36.39%(723/1987),而移植囊胚的临床妊娠率分别为52.3%(182/348)和55.37%(397/717),两组间比较均无显著性差异(P>0.05)。人绒毛膜促性腺激素(HCG)阳性率、流产率和异位妊娠率等两组间比较也均无显著性差异(P>0.05)。结论冻融胚胎移植激素替代周期中,采用两种不同剂量不同频次的阴道用黄体酮软胶囊治疗作为黄体支持,能够达到相似的临床疗效。

多囊卵巢综合征患者多原核合子的发生对冻胚移植结局的影响

目的比较多囊卵巢综合征(PCOS)人群多原核(PN)合子的发生率对体外受精(IVF)周期胚胎发育情况及冻融胚胎移植(FET)结局的影响。方法回顾性分析2016年1月至2021年12月于南京医科大学附属妇产医院进行IVF治疗的2665例患者资料。根据不孕原因分为PCOS组(N=1295)和对照组(N=1370),比较两组多PN发生率。在PCOS组中进一步仅纳入全胚冷冻并进行FET的患者,排除失访或未到分娩日期的患者,最终纳入999例PCOS患者,根据受精情况分为三个亚组:2PN组547例,低比例多PN组(多PN率≤20%)414例,高比例多PN组(多PN率>20%)38例,比较三个亚组的临床结局。结果PCOS组多PN率高于对照组(P<0.05)。低比例多PN组基础AMH、获卵数、IVF卵子数高于2PN组(P<0.05),可移植胚胎数、囊胚形成率、优质囊胚数低于2PN组(P<0.05),生化妊娠率和活产率低于2PN组(P<0.05)。高比例多PN组获卵数、IVF卵子数低于低比例多PN组(P<0.05),可移植胚胎数、囊胚形成率、优质囊胚数低于2PN组和低比例多PN组(P<0.05),生化妊娠率和活产率低于2PN组和低比例多PN组(P<0.05)。各组间胚胎种植率和临床妊娠率无统计学差异(P>0.05)。结论行FET的PCOS患者多PN发生会降低胚胎质量,影响生化妊娠率和活产率。

A frozen-thawed embryo transfer program improves the embryo utilization rate

Background Frozen-thawed embryo transfer （FET） is the most common way to prevent serious late ovarian hyperstimulation syndrome and increase the cumulative pregnancy rate. We evaluated the effectiveness of an FET program for improving the embryo implantation and clinical pregnancy rates, and ultimate embryo utilization rate in infertility treatment. Methods Patients undergoing in vitro fertilisation （IVF） cycles from January 2006 to June 2008 were enrolled, including 179 patients who had undergone the first FET cycle after controlled ovarian hyperstimulation （COH） in which all embryos were frozen （group C1） and 1306 patients who had COH with fresh embryo transfer （ET） （group T1）. Logistic regression was used to model the embryo implantation and clinical pregnancy rates based on the mother＇s age, numbers of oocytes retrieved, embryos transferred and high-quality embryos transferred. The embryo implantation and clinical pregnancy rates were also compared between two groups after adjusting for age, the numbers of oocytes retrieved and the numbers of embryos transferred. Results Logistic regression analysis confirmed that embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than those in group T1 after adjusting for confounding factors （43.6% vs 29.0%, 63.1% vs 47.0%, respectively; P 〈0.01）. The embryo implantation and clinical pregnancy rates were consistently higher in group C1 by comparing the age groups ≥35 or 〈35 years. The clinical pregnancy rates for the numbers of oocytes retrieved per cycle being ≥15 or 〈15 were higher in group C1, as was the embryo implantation rate. These differences were statistically significant for oocyte numbers 〉15 （P 〈0.05）. The embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than in group T1 when two or three embryos were transferred （P 〈0.05）. Conclusion A program of freezing all embryos and performing FET improved the rates of embryo implantation and clinical pregnancy, and ultimately enhanced the embryo utilization rate.

拮抗剂方案新鲜胚胎移植和冻融胚胎移植临床结局比较

目的 比较拮抗剂方案中行新鲜胚胎移植和冻融胚胎移植的临床结局。方法 回顾性分析2575例患者行拮抗剂方案助孕的临床资料,其中鲜胚移植周期1328例,冻胚移植周期1247例。结果冻胚移植组的血清AMH值、AFC显著高于鲜胚移植组,差异有统计学意义(P<0.05),其余基础资料无统计学差异(P>0.05)。冻胚移植组hCG日FSH低于鲜胚移植组,E2、P高于鲜胚移植组,差异有统计学意义(P<0.05)。冻胚移植组的获卵数、成熟卵子数、优质胚胎数均显著高于鲜胚组,差异有统计学意义(P<0.05)。冻胚移植组的移植胚胎数显著低于鲜胚移植组,临床妊娠率、着床率、活产率显著高于鲜胚移植组,异位妊娠率、多胎妊娠率显著低于鲜胚移植组,差异有统计学意义(P<0.05)。两组的中重度OHSS发生率、流产率、妊娠期糖尿病发生率、妊娠期高血压发生率差异无统计学意义(P>0.05)。冻胚移植组的单胎出生体重显著高于鲜胚移植组,差异有统计学意义(P<0.05)。结论 拮抗剂方案中冻胚移植亦可获得较好的临床结局,可作为一种有效的补充方案。

Different endometrial preparation protocols yield similar pregnancy outcomes for frozen-thawed embryo transfer in patients with advanced endometriosis

Objective To explore the different endometrial preparation for frozen-thawed embryo transfer （FET） in women with advanced endometriosis （EMS）. Methods The pregnancy outcomes of patients with advanced EMS （542 cycles）, who were prepared for FET, were retrospectively assessed. Included patients underwent a total of 233 FET cycles （180 patients） using natural cycle （NC）, a total of 142 FET cycles （115 patients） using letrozole （LE） ovulation induction, and a total of 167 FET cycles （137 patients） using hormonal replacement treatment （HRT） for endometrial preparation.Results There were no significant diffenences in the clinical pregnancy rate （LE： 49.30%, NC： 50.21%, and HRT： 43.11~/o, P=0.343）, the implantation rate （LE： 29.26%, NC： 36.03%, and HRT： 29.55%, P=0.084）, and the live birth rate （LE： 38.02%, NC： 39.11%, and HR T.＂ 35.33 %, P=O. 648） among the three groups. No statistically signifi- cant differences were observed in the ongoing pregnancy rate, the miscarriage rate, and the pregnancy complication rate. The single birth weight in patients using NC- FET was lower than that in patients using HRT-FET （P=0.044） and a higher twin birth weight in patients using LE-FET were observed compared with other groups （P=O. 022）. The rate of birth weight 〈2 500 g was also higher in the NC-FET group than in other groups. No congenital birth defects were found in the three groups. Conclusion Different endometrial preparation protocols without ultra-long GnRH-a down-regulation for FET yield similar pregnancy outcomes in patients with EMS. A tailored endometrial preparation protocol should be recommended according to different patients＇ situation.

Clomiphene Citrate as An Adjuvant to hMG Stimulation of the Ovaries in Mid-to-late Follicular Phase and Subsequently Pregnancy Outcome of Frozen-thawed Embryo Transfers

Objective To compare the results of a novel regimen of human menopausal gonadotrophin （hMG） in combination with clomiphene citrate （CC） in mid-to-late follicular phase with those of a short protocol of GnRH agonist （GnRHa） and hMG used for IVF. Methods In the retrospective study, 842 patients undergoing IVF were collected and classified into two groups： hMG in combination with CC in mid-to-late follicular phase （group A, n=319） and short protocol of GnRHa-hMG （group B, n=523）. The main outcome measures were ovarian responses in stimulation cycles and pregnancy outcomes in subsequent frozen-thawed embryo transfer （FET） cycles. Results In group A, the serum LH concentration on day 8 -10 was similar with that on the day of hCG administration （2.43 ± 1.92 IU vs 2.51 ±2.05 IU）. The number of mature follicles and oocytes retrieved was significantly lower in group A than in group B while the fertilization rate and the cleavage rate were comparable. The clinical pregnancy rate （47. 79% vs 48.04%）, the implantation rate （32.49% vs 33.11%） and the cumulative pregnancy rate （58.09% vs 60.22%） were respectively similar in group A and group B. Conclusion hMG in combination with CC in mid-to-late follicular phase results in the same pregnancy outcome as short protocol. The novel protocol may take the advantage of eliminating the occurrehce of a premature endogenous LH Surge.

冻融胚胎移植中舌象和脉象指标与活产结局的相关性研究

目的探讨冻融胚胎移植(FET)患者舌象和脉象指标与活产结局的相关性,及其与患者内分泌指标的关联性。方法本研究于2021年3月8日-2022年1月5日在上海中医药大学附属曙光医院生殖医学中心进行。根据活产结局将FET患者分为活产组和非活产组。分析两组的内分泌指标[基础促卵泡生成素(b FSH)、基础促黄体生成素(b LH)、基础雌二醇(bE_(2))、基础孕酮(bP)、基础子宫内膜厚度、内膜转换日促卵泡生成素(FSH)、内膜转换日促黄体生成素(LH)、内膜转换日雌二醇(E_(2))、内膜转换日孕酮(P)、内膜转换日子宫内膜厚度]与舌象和脉象指标[舌质(TB)-L,TB-a,TB-b,舌苔(TC)-L,TC-a,TC-b,perAll,perPart,h_(1),h_(4),h_(5),t_(1),h_(1)/t_(1),h_(4)/h_(1)]之间的差异,并用Spearman相关系数分析以上变量之间的相关性。采用多元logistic回归分析方法,筛选基于不同数据集的活产预测模型中的影响因素,包括仅由内分泌指标组成的模型1、仅由舌象和脉象指标组成的模型2、由舌象和脉象指标以及内分泌指标组成的模型3,并对不同数据集模型的有效性进行评价。结果研究纳入活产组78例,非活产组144例。与非活产组相比,活产组的TB-L(P=0.01)和TB-a(P=0.04)升高,b FSH(P=0.01)、perAll(P=0.04)和h_(4)/h_(1) P=0.03]降低。Spearman相关分析显示,活产组的TB-L、TB-b、TC-L、TC-b、perAll、perPart、h_(4)、h_(5)、t_(1)、h_(1)/t_(1)与b FSH、bLH、基础子宫内膜厚度、内膜转换日LH、内膜转换日E_(2)、内膜转换日P、内膜转换日子宫内膜厚度的相关性均有统计学意义(P<0.05)。多元logistic回归分析显示,模型3[曲线下面积(AUC):0.917,95%置信区间(CI):0.863-0.971,P<0.001]优于模型1(AUC:0.698,95%CI:0.593-0.803,P=0.001)和模型2(AUC:0.790,95%CI:0.699-0.880,P<0.001)。将舌象和脉象指标与内分泌指标相结合,建立活产结局的回归方程,最终纳入以下指标:内膜转换日FSH[比值比(OR):0.523,P=0.025]、内膜转换日LH(OR:1.277;P=0.029)、TB-L(OR:2.401,P=0.001)、perPart(OR:1.018,P=0.013)、h_(1)(OR:0.065,P=0.021)、t_(1)(OR:4.354,P=0.024)、h_(4)/h_(1)(OR:0.018,P=0.016)。结论在接受FET治疗的不孕症患者中,舌象和脉象指标与内分泌指标之间存在相关性。舌象和脉象指标的加入显著提高了模型对活产结局的预测能力。具体而言,舌象和脉象指标TB-L、PerPart、h_(1)、t_(1)和h_(4)/h_(1)与最终的活产结局有明显的相关性。

宫腔镜子宫内膜息肉手术后冻融胚胎移植时机对妊娠结局的影响

目的:探讨宫腔镜子宫内膜息肉手术至术后第1次冻融胚胎移植(frozen-thawed embryo transfer,FET)周期的间隔时间对妊娠结局的影响。方法:回顾性分析2021年1月—2023年7月在南京医科大学附属妇产医院进行FET治疗的患者临床资料,入组患者在体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)周期因内膜因素采用了全胚胎冷冻,后行宫腔镜子宫内膜息肉切除术,并在术后进行第1次FET。根据宫腔镜子宫内膜息肉手术后FET时机分为3组:息肉术后第1次月经来潮后FET治疗组(A组)303个周期、息肉术后第2次月经来潮后FET治疗组(B组)159个周期、息肉术后第3~6次月经来潮后FET治疗组(C组)79个周期。结果:C组患者有剖宫产手术史者占比与A组相似,但高于B组,3组比较差异有统计学意义(16.5%vs.9.9%vs.6.3%,P=0.045)。3组患者的其他临床资料比较,差异无统计学意义(均P>0.05)。与A组和C组相比,B组的种植率(58.8%vs.48.0%vs.34.1%,P<0.001)和临床妊娠率(75.5%vs.63.0%vs.50.6%,P<0.001)明显升高。B组的持续妊娠率与A组相似,但明显高于C组(67.3%vs.57.1%vs.46.8%,P=0.008)。3组的早期流产率差异无统计学意义(P=0.869)。二元Logistic回归校正混杂因素后,3组的持续妊娠率差异无统计学意义(P>0.05)。结论:宫腔镜子宫内膜息肉手术后第1次月经来潮进行FET治疗的妊娠结局与延迟治疗类似,为减少患者等待过程中的精神负担并缩短到达妊娠的时间,推荐息肉术后尽快安排FET治疗。

经皮雌二醇凝胶在血栓前状态患者冻融胚胎移植中的应用

目的探讨经皮雌二醇凝胶在血栓前状态患者激素替代周期(HRT)冻融胚胎移植(FET)中的应用价值。方法选取2021年2月至2023年2月在郑州大学第二附属医院生殖医院行HRT-FET助孕的血栓前状态患者68例为研究对象,其中采用经皮雌二醇凝胶进行内膜准备者为研究组(n=32),采用口服芬吗通进行内膜准备者为对照组(n=36),两组均在胚胎移植后给予低分子肝素治疗。比较两组HRT情况和FET妊娠结局,并比较同组胚胎移植前、移植后14 d以及组间移植后14 d的纤维蛋白原(FIB)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、凝血酶时间(TT)及D-二聚体(D-D)水平。结果研究组孕酮转化日子宫内膜厚度及A型子宫内膜比例显著高于对照组(P<0.05)。两组患者间移植胚胎数、移植优胚率、HCG阳性率比较均无显著差异(P>0.05),研究组临床妊娠率显著高于对照组(65.63%vs.41.67%,P<0.05),研究组早期流产率较对照组有所减低(9.38%vs.16.67%)但无显著差异(P>0.05)。两组患者胚胎移植后14 d的FIB及D-D水平均显著低于移植前(P<0.01),且胚胎移植后14 d研究组D-D及FIB水平显著低于对照组(P<0.01)。结论在血栓前状态患者HRT-FET周期中,与口服芬吗通比较,采用经皮给药的方式更能降低血栓前状态风险,提高子宫内膜容受性,改善助孕结局。因此针对这类患者,建议选择经皮雌激素进行内膜准备,并辅以肝素对症处理。

血清E2/P、AMH及25(OH)D3水平在冻融胚胎移植妊娠中的临床意义

目的分析血清雌二醇(E2)/孕酮(P)值、抗苗勒管激素(AMH)、血清25羟维生素D3[25(OH)D3]水平在冻融胚胎移植技术(FET)妊娠中的临床意义。方法选取2020年1月至2023年6月邯郸市中心医院收治的214例不孕患者作为研究对象,根据妊娠结局分为妊娠组和未妊娠组。比较两组相关资料;采用多因素Logistic回归分析影响FET妊娠结局的危险因素;采用ROC曲线评估E2/P、AMH及25(OH)D3对FET妊娠结局的预测价值。结果214例接受FET的患者中,共确诊临床妊娠104例(妊娠组),未妊娠者110例(未妊娠组),临床妊娠率为48.59%,两组年龄、移植胚胎数、子宫内膜厚度、E2/P、AMH、25(OH)D3水平比较,差异有统计学意义(P<0.05);经多元Logistic回归分析可知,E2/P、AMH、25(OH)D3值偏低、子宫内膜厚度小、高龄均是影响FET妊娠结局的危险因素(P<0.05);ROC曲线显示,E2/P、AMH与25(OH)D3三者联合预测的AUC值高于各指标单独检测者(P<0.05)。结论血清E2/P、AMH及25(OH)D3水平与不孕患者FET妊娠结局有一定关系,三者联合检测能够更全面地评估患者的妊娠潜力和风险,为临床制定个性化的治疗方案提供参考依据。

冻融单胚胎移植后早期血清β-HCG水平对活产结局的预测价值

目的探讨冻融单胚胎移植后早期血清β-HCG水平对活产结局的预测价值。方法回顾性分析2020年1月至2022年12月于烟台市烟台山医院生殖医学中心行单卵裂期胚胎移植(SCT-D3)后第14天β-HCG(β-HCG14)值及单囊胚移植(SBT-D5/6)后第12天β-HCG(β-HCG12)值均阳性的322个解冻周期患者的临床资料,根据妊娠结局分为生化妊娠组(n=52)、早期流产组(n=47)、活产组(n=223)3组,并对女方年龄(<35岁、≥35岁)进行亚组分层。采用二元Logistic回归分析筛选活产相关预测因子,相关及偏相关分析血清β-HCG水平对活产的影响,绘制β-HCG预测活产的受试者工作特征(ROC)曲线并确定阈值。结果不同妊娠结局组的早期β-HCG水平差异有统计学意义(H=132.628,P<0.001),活产组显著高于其他2组(P<0.001)。二元Logistic回归分析结果显示,女方年龄[OR=0.460,95%CI(0.248,0.855),P=0.014]、移植胚胎质量[OR=2.034,95%CI(1.070,3.868),P=0.030]、早期β-HCG水平[OR=1.004,95%CI(1.003,1.005),P=0.000]是冻融单胚胎移植活产的独立预测因子。ROC曲线分析显示,早期β-HCG预测活产的曲线下面积(AUC)为0.867,敏感度0.937,特异性0.677,临界值为265.5 U/L,并且高龄组预测阈值(341.2 U/L)高于低龄组(240.9 U/L)。结论女方年龄、移植胚胎质量、早期β-HCG水平是冻融单胚胎移植活产的独立预测因子;早期β-HCG预测活产ROC曲线在女方不同年龄分层中存在一定差异,但总体预测价值较高,各中心可定义自身活产预测期望值。

不同黄体酮给药方案对行胚胎植入前遗传学检测的冻融胚胎移植患者的影响及治疗成本分析

目的分析不同黄体酮给药方案对行胚胎植入前遗传学检测的冻融胚胎移植(PGT-FET)患者的影响及治疗成本。方法回顾性分析2020年8月至2022年7月在十堰市太和医院生殖医学中心进行PGT-FET的169例不孕患者的临床资料,根据患者采用的黄体酮给药方案将其分为A组(黄体酮胶囊口服,82例)和B组(黄体酮软胶囊阴道上药,87例)。比较两组注射人绒毛膜促性腺激素(HCG)日激素指标及获卵情况、注射HCG日和移植日子宫内膜厚度及容受性指标[阻力指数(RI)、搏动指数(PI)和收缩期峰值流速/舒张末期流速(S/D)]、囊胚移植、妊娠结局、阴道出血情况及成本-效果比。结果两组注射HCG日促黄体生成素(LH)、注射HCG日雌二醇(E2)、注射HCG日孕酮(P)、获卵数、MⅡ卵子数,注射HCG日和移植日子宫内膜厚度及子宫动脉S/D、RI、PI,移植囊胚数、移植优质囊胚率、生化妊娠率、临床妊娠率、早期流产率及继续妊娠率比较差异无统计学意义(P>0.05)。A组阴道早期出血率和晚期出血率显著低于B组(P<0.05)。A组成本-效果比为6.72,低于B组的8.41。结论PGT-FET患者采用黄体酮胶囊口服治疗与黄体酮软胶囊阴道上药治疗所获临床效果及对子宫内膜容受性的保护作用较为接近,但前者可以降低阴道出血率和治疗成本。