改良超长激素替代方案改善胚胎种植失败患者冻融胚胎移植妊娠结局

发布时间：2018-03-19 11:34

本文选题：胚胎移植　切入点：激素替代疗法　出处：《第二军医大学学报》2017年07期 　论文类型：期刊论文

【摘要】：目的探讨改良超长激素替代方案对既往胚胎种植失败再行冻融胚胎移植(FET)患者妊娠结局的影响。方法选择2015年1月至2017年1月于第二军医大学长海医院生殖医学中心体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)着床失败再次行FET的患者669例,根据本次FET周期子宫内膜准备方案分为2组:改良超长激素组(n=184)患者接受改良超长激素替代方案,单纯激素组(n=485)患者接受单纯激素替代方案。回顾性分析2种子宫内膜准备方案对患者妊娠结局的影响。结果 2组患者的年龄、体质量指数、不孕年限、移植胚胎数、转化日子宫内膜厚度、移植日子宫内膜厚度差异均无统计学意义(P0.05);改良超长激素组的优质胚胎率低于单纯激素组(50.9%vs 64.8%,P0.01),但囊胚移植率高于单纯激素组(57.4%vs 18.3%,P0.01);改良超长激素组胚胎着床率和临床妊娠率均高于单纯激素组,差异有统计学意义(29.8%vs 23.8%,46.7%vs 35.9%;P均0.05)。临床妊娠的logistic多因素回归分析提示,囊胚移植率和优质胚胎率是临床妊娠的独立影响因素。按照移植胚胎胎龄进行的亚组分析结果显示,卵裂期胚胎移植周期中,虽然单纯激素组的优质胚胎率高于改良超长激素组(67.5%vs 58.0%,P0.05),但两组的胚胎着床率和临床妊娠率差异均无统计学意义(23.0%vs 16.7%;34.9%vs 32.0%;P均0.05);在囊胚移植周期中,单纯激素组与改良超长激素组的优质胚胎率差异无统计学意义(52.7%vs 45.5%,P0.05),改良超长激素组的胚胎着床率和临床妊娠率均高于单纯激素组(39.6%vs 27.2%,56.9%vs 40.2%;P均0.05)。结论对于既往胚胎种植失败再次行FET助孕的不孕患者,改良超长激素替代方案可提高胚胎着床率及临床妊娠率,值得临床推广。
[Abstract]:Objective to investigate the effect of modified super-long hormone replacement protocol on pregnancy outcome in patients with frozen and thawed embryo transfer after failed embryo implantation. Methods from January 2015 to January 2017, reproductive medicine was selected in Changhai Hospital, second military Medical University. In vitro fertilization / intracytoplasmic sperm injection-embryo transfer (IVF / ICSI-ETT) implantation failed to perform FET again in 669 patients. According to the current FET cycle endometrial preparation program was divided into two groups: the modified super-long hormone group was treated with modified super-long hormone replacement regimen. The effects of two kinds of endometrial preparation regimen on pregnancy outcome were analyzed retrospectively. Results the age, body mass index, infertile years, number of embryos transferred in the two groups were analyzed retrospectively. The thickness of endometrium on the day of transformation, There was no significant difference in endometrial thickness on the day of transplantation; the rate of high quality embryos in the modified super long hormone group was lower than that in the simple hormone group (50.9 vs 64.8% P 0.01), but the blastocyst transfer rate was higher than that in the simple hormone group (57.4% vs 18.3% P 0.01); the embryo implantation rate and the impending rate in the modified super long hormone group were higher than those in the control group. The pregnancy rate in bed was higher than that in single hormone group. The difference was statistically significant (29.8 vs 23.8 vs 46.7 vs 35.9P). The multivariate logistic regression analysis showed that the rate of blastocyst transfer and the rate of high quality embryos were independent influencing factors of clinical pregnancy. The results of subgroup analysis according to the gestational age of transplanted embryos showed that the rate of blastocyst transfer and the rate of high quality embryos were independent factors of clinical pregnancy. In the cleavage embryo transfer cycle, although the rate of high quality embryos in the simple hormone group was higher than that in the modified super long hormone group (67.5 vs 58.0), there was no significant difference in embryo implantation rate and clinical pregnancy rate between the two groups (23.0 vs 16.734. 9 vs 32. 0% P 0. 05). In the blastocyst transfer cycle, there was no significant difference in embryo implantation rate and clinical pregnancy rate (P < 0. 05). There was no significant difference in the rate of high quality embryos between the simple hormone group and the modified super long hormone group. The embryo implantation rate and clinical pregnancy rate in the modified super long hormone group were higher than those in the simple hormone group (P < 0.05). Conclusion the embryo implantation rate and clinical pregnancy rate in the modified super long hormone group are higher than those in the simple hormone group (39.6 vs 27.2g / 56.9 vs 40.2%, P < 0.05). Conclusion for the former embryo species, the implantation rate and the clinical pregnancy rate of the modified super long hormone group are higher than those of the simple hormone group. The infertile patient who failed to receive FET to help pregnancy again, The modified super-long hormone replacement can increase embryo implantation rate and clinical pregnancy rate, which is worth popularizing.
【作者单位】：第二军医大学长海医院生殖医学中心;
【分类号】：R714.8

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