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| 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 |
| 刘苡萱,张慧琴,冯书改,朱旻,印惠荣,松迪,颜宏利,许亚军,洪毅,罗婷,吕妍,张青,施敏凤* |
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(第二军医大学长海医院生殖医学中心, 上海 200433
*通信作者) |
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| 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（P>0.05）；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%，P<0.01），但囊胚移植率高于单纯激素组（57.4% vs 18.3%，P<0.01）；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%，P<0.05），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%，P>0.05），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。 |
| 关键词: 胚胎移植 激素替代疗法 囊胚 妊娠结局 |
| DOI：10.16781/j.0258-879x.2017.07.0846 |
| 投稿时间：2017-04-19修订日期：2017-06-22 |
| 基金项目: |
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| Modified super-long hormone replacement protocol improves pregnancy outcome of previously failed implantation patients undergoing frozen-thawed embryo transfer |
| LIU Yi-xuan,ZHANG Hui-qin,FENG Shu-gai,ZHU Min,YIN Hui-rong,SONG Di,YAN Hong-li,XU Ya-jun,HONG Yi,LUO Ting,LÜ Yan,ZHANG Qing,SHI Min-feng* |
(Reproductive Medicine Center, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the influence of modified super-long hormone replacement protocol on pregnancy outcome of previous embryo implantation failure patients who underwent frozen-thawed embryo transfer (FET). Methods A total of 669 women who underwent FET with a failed history of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) were enrolled in Changhai Hospital of Second Military Medical University from Jan. 2015 to Jan. 2017. Based on different endometrial preparation protocols for FET, the patients were assigned to receive either modified super-long hormone replacement protocol (Modified super-long group, n=184) or conventional hormone replacement protocol (Conventional group, n=485).The pregnancy outcomes were retrospectively analyzed in the two groups. Results Patients in the two groups had similar baseline characteristics, including age, body mass index, duration of infertility, number of transferred embryo, endometrial thickness on transformation day and transplantation day (P>0.05). The good-quality embryo transfer rate in the Modified super-long group was significantly lower than that in the Conventional group (50.9% vs 64.8%, P<0.01), while the blastocyst transfer rate was significantly higher (57.4% vs 18.3%, P<0.01); compared with the Conventional group, the embryo implantation rate and clinical pregnancy rate in the Modified super-long group were both significantly increased (29.8% vs 23.8%, 46.7% vs 35.9%, respectively; both P<0.05). The logistics regression multivariate analysis in clinical pregnancy rate showed that the blastocyst transfer rate and good-quality embryo transfer rate were the influence factors for clinical pregnancy rate. Further subgroup analysis of different stage of transferred embryos showed that, in the cleavage embryo transferr cycles, the good-quality embryo transfer rate in the Conventional group was significantly higher than that in the Modified super-long group (67.5% vs 58.0%, P<0.05), but the embryo implantation rate and clinical pregnancy rate showed no significant difference between the two groups (23.0% vs 16.7%, 34.9% vs 32.0%, respectively; both P>0.05); however, in the blastocyst transfer cycles, although the good-quality embryo transfer rate had no significant difference between the two groups (45.5% vs 52.7%, P>0.05), the embryo implantation rate and clinical pregnancy rate in the Modified super-long group were significantly higher than those in the Conventional group (39.6% vs 27.2% and 56.9% vs 40.2%, respectively; both P<0.05). Conclusion The modified super-long hormone replacement protocol can improve the embryo implantation rate and clinical pregnancy rate of the patients undergoing FET with a history of embryo implantation failure, and is worthy of clinical popularization. |
| Key words: embryo transfer hormone replacement therapy blastula pregnancy outcome |
