PCOS患者不同子宫内膜准备方案冻胚移植结局分析

发布时间：2018-09-07 18:40

【摘要】：目的:探讨冻胚移植失败PCOS患者再次冻胚移植内膜准备的最佳方案。方法:回顾分析2011年8月~2013年7月在青岛市妇女儿童医院生殖中心行人工周期准备内膜冻融胚胎移植的PCOS患者的临床资料,对移植失败或因突破性出血取消周期尚有冻存胚胎的162例PCOS患者实施再次冻胚移植。将患者随机分为GnRHa+人工周期(降调节+人工周期组)、人工周期和诱导排卵方案3组,观察3组患者的年龄、体重指数(BMI)、不孕年限、胚胎冻存时间、突破性出血率、周期取消率、优质胚胎率、移植胚胎数、移植日子宫内膜厚度及类型、内膜增殖时间、内膜转化日血清雌激素浓度、种植率、妊娠率、流产率、异位妊娠率。结果:降调节+人工周期组和诱导排卵组无一例发生突破性出血。诱导排卵组内膜转化日E2平均水平为(2827.33±1148.49)pg/ml,高于其他2组,差异有统计学意义(P0.05);平均子宫内膜厚度为(9.14±0.90)mm,较其他2组增高,但差异无统计学意义(P0.05)。诱导排卵组的B级以下内膜所占比例最低,为9.76%,但差异无统计学意义(P0.05)。降调节+人工周期组的临床妊娠率和着床率分别为50.94%和22.54%,诱导排卵组分别为53.66%和22.77%,与人工周期组(31.03%,13.07%)比较,差异均有统计学意义(P0.05)。结论:对于PCOS患者,初次冻胚移植失败后再次冻胚移植时采用降调节+人工周期方案或诱导排卵方案,可降低突破性出血率,减少周期取消,提高妊娠率和着床率。
[Abstract]:Objective: to explore the best method for preparing the endometrium of frozen embryo transplantation (PCOS) in patients with failed frozen embryo transplantation. Methods: the clinical data of PCOS patients undergoing artificial cycle preparation for frozen-thawed embryo transfer in the reproductive center of Qingdao Women and Children Hospital from August 2011 to July 2013 were retrospectively analyzed. Frozen embryo transfer was performed in 162 patients with PCOS who failed in transplantation or whose embryo was frozen due to the cancellation of breakthrough hemorrhage. The patients were randomly divided into three groups: GnRHa artificial cycle group, artificial cycle group and induced ovulation group. The age, body mass index (BMI),) infertility, embryo cryopreservation time, breakthrough bleeding rate and cycle cancellation rate were observed. The rate of high quality embryos, the number of embryos transferred, the thickness and type of endometrium on the day of transplantation, the time of endometrial proliferation, the concentration of serum estrogen, implantation rate, pregnancy rate, abortion rate and ectopic pregnancy rate on the day of endometrial transformation. Results: no breakthrough hemorrhage occurred in the artificial cycle group and ovulation induction group. The average level of E _ 2 was (2827.33 卤1148.49) pg/ml, in the ovulatory group and (9.14 卤0.90) mm, in the other two groups (P0.05), but the difference was not significant (P0.05). The proportion of subgrade B endometrium in ovulation induction group was the lowest (9.76%), but the difference was not statistically significant (P0.05). The clinical pregnancy rate and implantation rate were 50.94% and 22.54% in the artificial cycle group, 53.66% and 22.77% in the induced ovulation group, respectively, which were significantly different from those in the artificial cycle group (31.03%, 13.07%) (P0.05). Conclusion: for patients with PCOS, artificial cycle or ovulation induction regimen can decrease the rate of breakthrough bleeding, reduce cycle cancellations, and increase pregnancy rate and implantation rate.
【作者单位】：青岛市妇女儿童医院生殖中心;郑州大学第一附属医院生殖中心;
【分类号】：R714.8

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