摘要
目的探讨应用长效促性腺激素释放激素类药物(GnRH-a)降调节后人工周期方案和单纯人工周期方案准备内膜对多囊卵巢综合征(PCOS)患者冻胚移植妊娠结局的影响。方法回顾性分析湖南省妇幼保健院生殖中心2016年11月至2017年10月132例PCOS患者行冷冻胚胎移植的情况。根据患者冻胚移植前子宫内膜准备方案的不同分为GnRH-a降调节+人工周期组(n=66)和单纯人工周期组(n=66),比较两组患者移植周期、妊娠结局的情况。结果⑴两组患者的年龄、原发不孕比例、不孕年限、BMI差异均无统计学意义(P> 0. 05)。⑵单纯人工周期组66例,有4例取消移植,其中因突破性出血取消移植2例,因内膜厚度<7 mm取消移植2例,移植62例。长效GnRH-a降调节+人工周期组移植66例,无取消病例。两组患者移植周期取消率比较差异有统计学意义(χ2=4. 13,P=0. 04)。两组患者胚胎冻存时间、鲜胚周期获卵数、冷冻胚胎复苏率、移植胚胎数、移植优质胚胎数、转化日子宫内膜厚度比较差异均无统计学意义(P> 0. 05)。长效GnRH-a降调节+人工周期组患者转化日雌激素水平、促黄体生成素(LH)水平分别为(1 439. 38±357. 43) nmol/ml和(2. 32±0. 94) m IU/ml,单纯人工周期组转化日雌激素水平、LH水平分别为(1 580. 54±479. 69)nmol/ml和(9. 46±1. 52) m IU/ml,两组差异有统计学意义(t=53. 64,P <0. 001; t=14. 32,P <0. 001)。⑶长效GnRH-a降调节+人工周期组和单纯人工周期组患者生化妊娠率分别为72. 73%和53. 23%,差异有统计学意义(χ2=5. 23,P=0. 036)。GnRH-a降调节+人工周期组患者临床妊娠率(65. 15%)高于单纯人工周期组(46. 77%),差异有统计学意义(χ2=4. 39,P=0. 022)。两组患者早期流产率、异位妊娠率比较差异无统计学意义(P> 0. 05)。结论 PCOS患者冻胚移植周期时长效GnRH-a降调节后人工周期方案优于单纯人工周期方案,能显著降低周期取消率,降低子宫内膜转化日
Objective To assess the effects of artificial cycle after long-acting gonadotropin-releasing hormone (GnRH)agonist down regulation scheme and artificial cycle only scheme in preparation of endometrium before frozen embryo transfer in polycystic ovary syndrome (PCOS)patients on pregnancy outcome.Methods A retrospective analysis was made on the frozen embryo transfer of 132PCOS patients in the reproductive center of Hunan Maternal and Child Health Hospital from November 2016to October 2017. The patients were divided into GnRH-a down regulation + artificial cycle group (n =66)and simple artificial cycle group (n =66)according to the different endometrial preparation schemes before frozen embryo transplantation.The transplantation cycle and pregnancy outcome of the two groups were compared.Results (1)There was no statistically significant difference in age,primary infertility rate,infertility years and body mass index (BMI)between the two groups (P >0.05).(2)In the artificial cycle group,4cases in which the transplantation was cancelled,including 2cases who were cancelled due to breakthrough bleeding and 2 cases due to endometrial thickness that were less than 7mm.There was a statistically significant difference in the cancellation rate between the two groups (χ^2=4.13,P =0.04).There were no statistically significant difference in embryo frozen storage time,retrieved oocytes in fresh embryo cycle,frozen thawed embryos in the survival rate,graftage embryonic number,high-quality embryonic rate,endometrium thickness in conversion day (P >0.05).Estrogen level,luteinizing hormone (LH)levels on endometrium conversion day in GnRH-a down regulation plus artificial cycle group and artificial cycle group were respectively as [(1439.38±357.43)nmol/ml vs (1580.54±479.69)nmol/ml and (2.32±0.94)mIU/ml vs (9.46± 1.52)mIU/ml],with statistically significant difference (χ^2=53.64,P <0.001;χ^2=14.32,P < 0.001).(3)The biochemical pregnancy rates of the patients in the GnRH-a down regulation plus artificial cycle group and artific
作者
吴晓丽
禹虹
唐慧珍
陈辉莲
钟垚
陈圜圜
柳朝华
Wu Xiaoli;Yu Hong;Tang Huizhen;Chen Huilian;Zhong Yao;Chen Yuanyuan;Liu Zhaohua(Reproductive Medicine Center,Hunan Provincial Maternal and Child Health Care Hospital,Changsha 410008,China)
出处
《中国医师杂志》
CAS
2018年第11期1637-1640,1646,共5页
Journal of Chinese Physician
基金
湖南省卫生计生委基金项目(20190795)~~
关键词
促性腺素释放激素
多囊卵巢综合征
胚胎移植
子宫内膜
Gonadotropin-releasing hormone
Polycystic ovary syndrome
Embryo transfer
Endometrium
