影响薄型子宫内膜冻融胚胎移植妊娠结局的相关因素分析

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摘要目的比较薄型子宫内膜患者行冻融胚胎移植(FET)时自然周期(NC)、激素替代周期(HRT)及降调节+HRT三种内膜准备方案的妊娠结局。方法选取2018年08月至2019年07月于南京医科大学附属南京市妇产医院生殖医学中心行FET的患者,选取转化日子宫内膜厚度小于8 mm的患者作为研究对象,进行回顾性研究。患者年龄23～45岁,不孕年限1～17年。根据内膜准备方案分为NC组、HRT组及降调节+HRT组,比较三组的基本情况及妊娠结局。结果三组患者的年龄、不孕时间、体重指数(BMI)、基础卵泡刺激素(FSH)水平、基础黄体生成素(LH)水平、基础雌二醇(E2)水平、移植胚胎数、囊胚占比差异均无统计学意义。三组患者移植日子宫内膜厚度、生化妊娠率、流产率及宫外孕率比较,差异均无统计学意义。NC组临床妊娠率(56.9%)及胚胎种植率(40.0%)略高于HRT组(分别为44.7%,32.7%)及降调节+HRT组(分别为50.5%,35.2%),但差异均无统计学意义。单因素分析显示,NC组获得临床妊娠概率高于HRT组;多因素分析显示,NC组获得临床妊娠的概率为HRT组的2.11倍,差异有统计学意义。ROC曲线(受试者工作曲线)发现,子宫内膜厚度的ROC曲线下面积为0.579(P <0.05)。Youden指数(约登指数)最大为0.160,薄型子宫内膜获得较好临床妊娠结局Cut-off 值为0.705 cm。结论薄型子宫内膜患者FET内膜准备方案中,NC种植率高于HRT及降调节+HRT,但妊娠结局差异无统计学意义;排除混杂因素后,NC妊娠结局高于HRT。临床上可根据患者自身特点选择合适的方案。

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	李欣
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	苏雁
	季晓媛
	丁卉

关键词 ：冻融胚胎移植(FET), 薄型子宫内膜, 自然周期(NC), 激素替代周期(HRT)

Abstract：Objective To compare the pregnancy outcomes of three endometrial preparation schemes:natural cycle (NC), hormone replacement cycle (HRT) and hyporegulation + hormone replacement cycle in freeze-thaw embryo transfer (FET). Methods Patients who underwent FET in the reproductive medicine center of Nanjing Maternal and child health care institute affiliated to Nanjing Medical University from August 2018 to July 2019 were selected. Patients with endometrial thickness less than 8 mm on the day of transplantation were selected as the study objects for retrospective study. According to the endometrial preparation plan, they were divided into three groups:HRT group, down regulation + HRT group and natural cycle group. Results There were no significant differences in age, infertility time, body mass index (BMI), basal follicle-stimulating hormone (FSH), basal luteinizing hormone (LH), basal estradiol (E2), number of transplanted embryos and proportion of blastocyst among the three groups. There was no significant differences in endometrial thickness, biochemical pregnancy rate, abortion rate and ectopic pregnancy rate on the day of transplantation among the three groups, while the clinical pregnancy rate (56.9%) and embryo implantation rate (40.0%) in natural cycle group were slightly higher than those in HRT group (44.7% vs 32.7%) and down regulation + HRT group (50.5%, vs 35.2%). Univariate analysis showed that the probability of clinical pregnancy in NC group was higher than that in HRT group; Multivariate analysis showed that the probability of clinical pregnancy in NC group was 2.11 times higher than that in HRT group, and the difference was statistically significant. ROC curve (subject working curve) found that the area under the ROC curve of endometrial thickness was 0.579, and the difference was statistically significant (P<0.05). The maximum Youden index (yoden index) was 0.160. Thin endometrium achieved better clinical pregnancy outcome, and the cut-off value was 0.705 cm. Conclusion In the endometrial preparation scheme of FET in patients with thin endometrium, the NC implantation rate is higher than that of HRT and down regulation + HRT, but there is no significant difference in pregnancy outcome; After excluding confounding factors, the pregnancy outcome of NC was higher than that of HRT. Clinically, the appropriate scheme can be selected according to the characteristics of patients.

Key words： frozen thawed embryo transfer (FET) thin endometrium natural cycle(NC) hormone replacement cycle(HRT)

收稿日期: 2021-01-13

ZTFLH:

R71

基金资助:国家自然科学基金项目(81471457);南京医科大学科技发展基金面上项目(2017NJMU075)

通讯作者: 丁卉(546517601@qq.com)

引用本文:

李欣, 谢奇君, 赵纯, 凌秀凤, 苏雁, 季晓媛, 丁卉. 影响薄型子宫内膜冻融胚胎移植妊娠结局的相关因素分析[J]. 中国生育健康杂志, 2022, 33(4): 305-310. LI Xin, XIE Qijun, ZHAO Chun, LING Xiu Feng, SU Yan, JI XiaoYuan, DING Hui. Clinical outcome analysis of different programmes of frozen embryo transfer in patients with thin endometrium. Chinese Journal of Reproductive Health, 2022, 33(4): 305-310.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2022/V33/I4/305

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