摘要
目的研究内膜准备方案及雌、孕激素水平对冻融两胚胎移植周期妊娠结局的影响。方法选取2017年4月至2018年3月于空军军医大学附属西京医院生殖医学中心行冻融胚胎移植的399例患者共计399个周期的临床资料进行回顾性分析,根据是否临床妊娠分为临床妊娠组(n=199)和非临床妊娠组(n=200)。将两组的女方年龄、男方年龄、不孕年限、转化日子宫内膜厚度、内膜形态、移植日血雌二醇(E_(2))和孕酮(P)水平、移植后第3天(D3)血E_(2)和P水平,以及胚胎质量进行比较;采用二元Logistic回归分析妊娠结局的影响因素;分析3种不同内膜准备方案间的差异。结果两组女方年龄、男方年龄、不孕年限、转化日子宫内膜厚度、内膜形态、移植日血清E_(2)和P水平比较,差异无统计学意义(P>0.05);临床妊娠组移植后D3血E_(2)和P水平显著低于非临床妊娠组,差异具有统计学意义(P<0.05)。移植后D3血E_(2)、P水平与临床妊娠结局无关(P>0.05),胚胎质量与临床妊娠结局有关(P<0.05)。自然周期与降调节激素替代周期转化日内膜厚度显著高于激素替代周期,差异具有统计学意义(P<0.05);降调节激素替代周期准备内膜使用雌激素时间显著低于替代周期(P<0.01)。结论移植后D3较高水平的血E_(2)和P水平可能对妊娠不利,降调节激素替代和自然周期方案能达到更厚的内膜,且降调节激素替代方案比激素替代方案雌激素用量要少。
Objective To study the influence of endometrium preparation program, serum estrogen and progesterone levels on pregnancy outcome of two frozen-thawed embryo transfer(FET).Methods Clinical data of 399 patients who underwent frozen-thawed embryo transplantation in Reproductive Medicine Center of Xijing Hospital Affiliated to Military Medical University from April 2017 to March 2018 were retrospectively analyzed, and they were divided into clinical pregnancy group(n=199) and non-clinical pregnancy group(n=200) according to whether they were clinically pregnant. Female age, male age, infertility years, endometrial thickness, endometrial morphology, blood estradiol(E_(2)) and progesterone(P) levels on the day of transplantation, blood E_(2)and P levels on the third day of transplantation(D3) and embryo quality were compared between the two groups. The influencing factors of pregnancy outcome were analyzed by binary Logistic regression. The differences among three different endometrial preparation schemes were analyzed. Results There were no significant differences between the two groups in female age, male age, infertility years, endometrial thickness, endometrial morphology, serum E_(2)and P levels on transplantation day(P>0.05). The levels of E_(2)and P in D3 after transplantation in clinical pregnancy group were significantly lower than those in non-clinical pregnancy group(P<0.05). After transplantation, D3 blood E_(2)and P levels were not related to clinical pregnancy outcome(P>0.05), but embryo quality was related to clinical pregnancy outcome(P<0.05). The endometrial thickness of natural cycle and down-regulated hormone replacement cycle was significantly higher than that of hormone replacement cycle(P<0.05). Down-regulating hormone replacement cycle the preparation time of endometrial estrogen use was significantly lower than that of replacement cycle(P<0.01). Conclusions Higher levels of blood E_(2)and P in D3 after transplantation may be detrimental to pregnancy. Thicker intima can be achieved with down-regulated hormone replacement and natural cycle regimens, and less estrogen is used in down-regulated hormone replacement regimens than in hormone replacement regimens.
作者
唐雪原
周冬梅
滑玮
宋晖
黄艳红
TANG Xueyuan;ZHOU Dongmei;HUA Wei;SONG Hui;HUANG Yanhong(Department of Reproductive Endocrinology,Xi'an International Medical Center Hospital,Xi'an 710100,Shaanxi,China;Reproductive Medical Center,Depart-ment of Obstetrics and Gynaecology,Xijing Hospital Affiliated to Military Medical University,Xi'an 710032,Shaanxi,China)
出处
《中国性科学》
2022年第1期59-63,共5页
Chinese Journal of Human Sexuality
基金
陕西省重点研发计划项目(2020ZDLSF03-01)。
关键词
冻融胚胎移植
内膜准备方案
胚胎质量
妊娠结局
Frozen-thawed embryo transfer
Endometrium preparation program
Embryo quality
Pregnancy outcome
作者简介
通讯作者:黄艳红,E-mail:530548813@qq.com。
