激素补充周期冻融胚胎移植临床妊娠结局的影响因素分析

发布时间：2018-01-29 21:09

本文关键词： 激素补充周期冻融胚胎移植临床妊娠结局内膜转化日回顾性研究　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:比较分析行激素补充周期—冻融胚胎移植(HRT—FET)治疗后,患者不同临床妊娠结局的影响因素,为不孕患者临床指导提供科学依据。方法:回顾性分析2010年1月至2015年12月浙江大学医学院附属妇产科医院因不孕行HRT—FET患者病例共6174个周期,其中包括每位研究对象的临床、实验室及随访资料。按临床妊娠结局阳性及阴性分为两组,通过单因素分析和二元logistic回归分析比较行HRT—FET患者临床妊娠结局的影响因素。探讨在不同年份行HRT-FET患者临床妊娠结局的差异性。比较分析HRT—FET内膜转化日血清雌孕激素水平对临床妊娠结局的影响。结果:在纳入本研究的6174个HRT—FET周期中,2586例(41.89%)临床妊娠阳性,3588例(58.11%)临床妊娠阴性,两组基础特征间的女方年龄、男方年龄、不孕年限、基础FSH水平、基础FSH/LH比值、冻融胚胎移植数目等差异有统计学意义(P0.05)。以上研究因素进行二元logistic回归分析后发现女方年龄(OR= 0.979,95%CI:0.965～0.992,P=0.002)、不育年限(OR=0.978,95%CI:0.979～1.009,P=0.023)、基础 FSH/LH 比值(OR=0.877,95%CI:0.814～0.944,P=0.001)、冻融胚胎移植数目(OR=1.448,95%CI:1.328～1.579,P0.001)是 HRT—FET患者临床妊娠是否成功的独立影响因素。根据冻融胚胎移植年份分为6组,其中各组间取卵周期指标(扳机日E2、扳机日P、取卵日内膜厚度、成熟卵泡数、优质胚胎数)以及冻融胚胎移植周期相关指标(胚胎体外培养天数、冻融胚胎移植数目、内膜转化日内膜厚度)差异均有统计学意义(P0.05),同时临床妊娠率及胚胎种植率有显著差异(P0.05)。根据内膜转化日血清雌激素水平分为三组,发现各组临床妊娠率无显著差异,仅内膜转化日内膜厚度差异有显著差异(.P0.05),内膜转化日血清雌激素水平与妊娠率呈负相关关系(r=-0.042),但不具有统计学意义(P0.05)。在对患者基础特征匹配后共654个冻融单胚胎移植周期中,仅移植桑椹胚对临床妊娠结局有显著影响(P0.05)。结论:女方年龄、不育年限、基础FSH/LH比值、冻融胚胎移植数目是预测患者HRT-FET临床妊娠结局的独立影响因素。在冻融胚胎移植数目逐年下降的情况下胚胎种植率呈逐年上升趋势。内膜转化日血清雌激素水平对HRT-FET患者临床妊娠结局无显著影响。
[Abstract]:Objective: To compare the hormone replacement cycle for frozen thawed embryo transfer (HRT - FET) after treatment, the pregnancy outcome in patients with different clinical factors, to provide scientific basis for clinical guidance of patients with infertility. Methods: a retrospective analysis from January 2010 to December 2015 and affiliated medical college of Zhejiang University hospital for infertility underwent HRT - FET patients with 6174 cases each cycle, including clinical research object, laboratory and follow-up data. According to the clinical pregnancy outcome of positive and negative were divided into two groups by single factor analysis and logistic regression analysis of influencing factors of two yuan compared to HRT - FET in patients with clinical pregnancy outcome. To investigate the differences in clinical outcomes in HRT-FET patients of different years for comparative analysis of effect of HRT FET on endometrial transformation level of serum estrogen and progesterone on pregnancy outcomes in clinic. Results: included in the study of 6174 HRT - FET cycle, 2586 cases (41.89%) positive clinical pregnancy, 3588 cases of clinical pregnancy (58.11%) negative, the woman's age, two groups basic characteristics between male age, infertility duration, basal FSH level, FSH/LH ratio, the number of frozen thawed embryo transfer was statistically significant (P0.05). To study on the factors of two yuan logistic regression the analysis found that the woman's age (OR= 0.979,95%CI:0.965 ~ 0.992, P=0.002), duration of infertility (OR=0.978,95%CI:0.979 - 1.009, P=0.023), FSH/LH ratio (OR=0.877,95%CI:0.814 ~ 0.944, P=0.001), frozen thawed embryo transfer number (OR=1.448,95%CI:1.328 ~ 1.579, P0.001) is HRT - FET in patients with clinical pregnancy factors independent of success. According to the freezing effect thawed embryo transplantation years were divided into 6 groups, each group between oocyte cycle indicators (E2, P, trigger, trigger, take eggs, the endometrial thickness of mature egg number, the number of high-quality embryos) and frozen thawed embryo transfer Index cycle (embryos in vitro culture days, the number of frozen thawed embryo transfer, transformation on intima-media thickness of endometrium) showed significant differences (P0.05), and the clinical pregnancy rate and implantation rate were significantly different (P0.05). According to the transformation on endometrial estrogen level in serum were divided into three groups, each group found no significant difference in clinical pregnancy rate there is a significant difference, only on the transformation of endometrial endometrial thickness difference (.P0.05), endometrial transformation on serum estrogen level was negatively correlated with pregnancy rate (r=-0.042), but was not statistically significant (P0.05). In the matching of patients after a total of 654 basic characteristics of freezing and thawing single embryo transfer cycle, only a morula transplantation significant influence on the clinical outcome of pregnancy (P0.05). Conclusion: the age, duration of infertility, FSH/LH ratio, the number of frozen thawed embryo transfer were independent predictors of pregnancy outcome in patients with clinical HRT-FET. In frozen thawed embryo The rate of embryo implantation is increasing year by year. The level of serum estrogen has no significant effect on the clinical pregnancy outcome of HRT-FET patients.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.8

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