不同人工周期子宫内膜准备方案在冷冻囊胚移植中的应用
|
摘要
目的对冷冻囊胚移植的患者采用人工周期方案(E-P)、促性腺激素释放激素激动剂(GnRH-α)+人工周期方案(GnRH-α+E-P)、口服避孕药+人工周期方案(OC+E-P)三种方法准备子宫内膜,探讨三种人工周期方案在冷冻囊胚移植中的临床应用。方法将我中心2016年6月至2017年3月因不孕接受冷冻囊胚移植的患者分为三组处理子宫内膜,A组196个冻融周期采用E-P方案;B组182个冻融周期采用GnRH-α+E-P方案;C组106个冻融周期采用OC+E-P方案。比较三组患者间年龄、BMI指数、不孕年限、基础FSH值、加用孕激素日雌激素水平、子宫内膜厚度、移植囊胚数、优质囊胚数、生化妊娠率、临床妊娠率和异位妊娠率之间的差异。结果 3组患者的年龄、BMI指数、不孕年限、基础FSH值、加用孕激素日雌激素水平、子宫内膜厚度、移植囊胚数、移植优质囊胚数和优质囊胚率之间差异无统计学意义(P≥0.05);GnRH-α+E-P方案组患者生化妊娠率和临床妊娠率高于单纯人工周期方案组,差异具有统计学意义(P<0.05),OC+E+P组的生化妊娠率和临床妊娠率与单纯人工周期方案组相比较差异无统计学意义(P≥0.05),3组间异位妊娠率比较差异无统计学意义(P≥0.05)。结论 GnRH-α用于冷冻囊胚移植人工周期准备子宫内膜的方案可以提高临床妊娠率。
Objective To compare the pregnancy outcomes of three hormone replacement therapy(HRT)protocols used to prepare the endometrium for frozen-thawed blastocyst transfer.Methods Retrospective analysis of clinical data with the patients received frozen-thawed blastocyst transfer from Jun.2016 to Mar.2017 in our center was performed.The patients were divided into three groups:group A(196 cycles)taked only HRT protocol(E-P);group B(182 cycles)taked gonadotrophin releasing hormone agonist(GnRH-α)plus HRT protocol(GnRH-α+E-P);group C(106 cycles)received oral contraceptive(OC)plus HRT protocol(OC+E-P).The age of the patients,etiology of female infertility,basal FSH,estrogen level and endometrial thickness on the day of progesterone initiation day,the number of blastocysts and high quality blastocysts,biochemical pregnancy rate,clinical pregnancy rate and ectopic pregnancy rate were compared between the three groups.Results There were no significant differences in the age of the patients,etiology of female infertility,basal FSH,estrogen level and endometrial thickness on the day of progesterone initiation day,the number of blastocysts and high quality blastocysts,biochemical pregnancy rate,clinical pregnancy rate and ectopic pregnancy rate between three groups(P≥0.05),but the biochemical pregnancy rate and the clinical pregnancy rate was significantly higher in group B than group A(P<0.05),while there were no statistical differences in biochemical pregnancy rate and clinical pregnancy rate between group A and group C(P≥0.05),in addition there was also no significant difference in ectopic pregnancy rate between the three groups(P≥0.05).Conclusion GnRH-αcan be used in the HRT to prepare the endometrium for frozen-thawed blastocyst transfer,which can improve the clinical pregnancy rate.
Objective To compare the pregnancy outcomes of three hormone replacement therapy(HRT)protocols used to prepare the endometrium for frozen-thawed blastocyst transfer.Methods Retrospective analysis of clinical data with the patients received frozen-thawed blastocyst transfer from Jun.2016 to Mar.2017 in our center was performed.The patients were divided into three groups:group A(196 cycles)taked only HRT protocol(E-P);group B(182 cycles)taked gonadotrophin releasing hormone agonist(GnRH-α)plus HRT protocol(GnRH-α+E-P);group C(106 cycles)received oral contraceptive(OC)plus HRT protocol(OC+E-P).The age of the patients,etiology of female infertility,basal FSH,estrogen level and endometrial thickness on the day of progesterone initiation day,the number of blastocysts and high quality blastocysts,biochemical pregnancy rate,clinical pregnancy rate and ectopic pregnancy rate were compared between the three groups.Results There were no significant differences in the age of the patients,etiology of female infertility,basal FSH,estrogen level and endometrial thickness on the day of progesterone initiation day,the number of blastocysts and high quality blastocysts,biochemical pregnancy rate,clinical pregnancy rate and ectopic pregnancy rate between three groups(P≥0.05),but the biochemical pregnancy rate and the clinical pregnancy rate was significantly higher in group B than group A(P<0.05),while there were no statistical differences in biochemical pregnancy rate and clinical pregnancy rate between group A and group C(P≥0.05),in addition there was also no significant difference in ectopic pregnancy rate between the three groups(P≥0.05).Conclusion GnRH-αcan be used in the HRT to prepare the endometrium for frozen-thawed blastocyst transfer,which can improve the clinical pregnancy rate.
引文
[1]Hill MJ,Miller KA,Frattarelli JL.A GnRH agonist and exogenous hormone stimulation protocol has a higher live-birth rate than a natural endogenous hormone protocol for frozen-thawed blastocyst-stage embryotransfer cycles:an analysis of 1391cycles[J].Fertil Steril,2010,93(2):416.
[2]Chen QJ,SUN XX,Li L,et al.Effects of ovarian high response on implantation and pregnancy outcome during controlled ovarian hyperstimulation(with GnRH agonist and rFSH)[J].ACTA Obstet Gynecol Scand,2007,86(7):849.
[3]Shapiro BS,Daneshmand ST,Garner FC,et al.Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization:aprospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders[J].Fertil Steril,2011,96(2):344.
[4]Weinerman R,Mainigi M.Why we should transfer frozen instead of fresh embryos:the translational rationale?[J].Fertil Steril,2014,102(1):10.
[5]Blake D,Farquhar CM,Johnson N,et al.Cleavage stage versus blastocyst stage embryo transfer in assisted conception[J].Cochrane Database Syst Rev,2007,17(4):CD002118.
[6]Reh A,Fino E,Krey L,et al.Optimizing embryo selection with day5transfer[J].Fertil Steril,2010,93(2):609.
[7]Givens CR,Markun LC,Ryan IP,et al.Outcomes of natural cycles versus programmed cycles for 1677frozen-thawed embryo transfers Reprod Biomed Online,2009,19(3):380.
[8]Ghobara T,Vandekerckhove P.Cycle regimens for frozen-thawed embryo transfer[J].Cochrane Database Syst Rev,2008(1):CD003414.
[9]Fatemi HM,Kyrou D,Bourgain C,et al.Cryopreserved-thawed human embryo transfer:spontaneous natural cycle is superior to human chorionic gonadotropin-induced natural cycle[J].Fertil Steril,2010,94(6):2054.
[10]Al-Inany H,van-Gelder P.Success of frozen embryo transfer:Does the type of gonadotropin influence the outcome?[J].Int J Womens Health,2010,2:89.
[11]郭慧,龚菲,罗克丽,等.两种雌孕激素替代法内膜准备对多囊卵巢综合征冷冻胚胎移植临床效果的比较[J].中国现代医学杂志,2013,23(2):74.
[12]Griesinger G,Weig M,Schroer A,et al.Mid-cycle serum levels of endogenous LH are not associated with the likelihood of pregnancy in artificial frozen-thawed embryotransfer cycles without pituitary suppression[J].Hum Reprod,2007,22(10):2589.
[13]Gelbaya T,Nardo L,Hunter H,et al.Cryopreservedthawed embryo transfer in natural or down-regulated hormonally controlled cycles:a retrospective study[J].Fertil Steril,2006,85(3):603.
[14]Bourgain C.Endometrial biopsy in the evaluation of endometrial receptivity[J].J Gynecol Obstet Biol Reprod(Paris),2004,33(1Pt2):S13.
[15]Glujovsky D,Pesce R,Fiszbajn G,et al.Endometrial preparation for women undergoing embryo transfer with frozen embryos or embryos derived from donor oocytes[J].Cochrane Database Syst Rev,2010(1):CD006359.
[16]Neukomm C,Mueller MD.New insights into the pathophysiology of endometriosis[J].Gynakol Geburtshilfliche Rundsch,2007,47(3):113.
[17]Koras,Bag PE,witt BR,et al.Hypothalminc-pituitary suppression with oral coneraceptive pills Does Not improve outcome in Poor Responder Patients Undergoing In Vitro Fertilization-Embryo Transfer Cycles[J].Assi Repro Genetics,2001,7:391.
[2]Chen QJ,SUN XX,Li L,et al.Effects of ovarian high response on implantation and pregnancy outcome during controlled ovarian hyperstimulation(with GnRH agonist and rFSH)[J].ACTA Obstet Gynecol Scand,2007,86(7):849.
[3]Shapiro BS,Daneshmand ST,Garner FC,et al.Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization:aprospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders[J].Fertil Steril,2011,96(2):344.
[4]Weinerman R,Mainigi M.Why we should transfer frozen instead of fresh embryos:the translational rationale?[J].Fertil Steril,2014,102(1):10.
[5]Blake D,Farquhar CM,Johnson N,et al.Cleavage stage versus blastocyst stage embryo transfer in assisted conception[J].Cochrane Database Syst Rev,2007,17(4):CD002118.
[6]Reh A,Fino E,Krey L,et al.Optimizing embryo selection with day5transfer[J].Fertil Steril,2010,93(2):609.
[7]Givens CR,Markun LC,Ryan IP,et al.Outcomes of natural cycles versus programmed cycles for 1677frozen-thawed embryo transfers Reprod Biomed Online,2009,19(3):380.
[8]Ghobara T,Vandekerckhove P.Cycle regimens for frozen-thawed embryo transfer[J].Cochrane Database Syst Rev,2008(1):CD003414.
[9]Fatemi HM,Kyrou D,Bourgain C,et al.Cryopreserved-thawed human embryo transfer:spontaneous natural cycle is superior to human chorionic gonadotropin-induced natural cycle[J].Fertil Steril,2010,94(6):2054.
[10]Al-Inany H,van-Gelder P.Success of frozen embryo transfer:Does the type of gonadotropin influence the outcome?[J].Int J Womens Health,2010,2:89.
[11]郭慧,龚菲,罗克丽,等.两种雌孕激素替代法内膜准备对多囊卵巢综合征冷冻胚胎移植临床效果的比较[J].中国现代医学杂志,2013,23(2):74.
[12]Griesinger G,Weig M,Schroer A,et al.Mid-cycle serum levels of endogenous LH are not associated with the likelihood of pregnancy in artificial frozen-thawed embryotransfer cycles without pituitary suppression[J].Hum Reprod,2007,22(10):2589.
[13]Gelbaya T,Nardo L,Hunter H,et al.Cryopreservedthawed embryo transfer in natural or down-regulated hormonally controlled cycles:a retrospective study[J].Fertil Steril,2006,85(3):603.
[14]Bourgain C.Endometrial biopsy in the evaluation of endometrial receptivity[J].J Gynecol Obstet Biol Reprod(Paris),2004,33(1Pt2):S13.
[15]Glujovsky D,Pesce R,Fiszbajn G,et al.Endometrial preparation for women undergoing embryo transfer with frozen embryos or embryos derived from donor oocytes[J].Cochrane Database Syst Rev,2010(1):CD006359.
[16]Neukomm C,Mueller MD.New insights into the pathophysiology of endometriosis[J].Gynakol Geburtshilfliche Rundsch,2007,47(3):113.
[17]Koras,Bag PE,witt BR,et al.Hypothalminc-pituitary suppression with oral coneraceptive pills Does Not improve outcome in Poor Responder Patients Undergoing In Vitro Fertilization-Embryo Transfer Cycles[J].Assi Repro Genetics,2001,7:391.