GnRH-a降调节及种植窗后移对反复种植失败患者妊娠结局的影响
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摘要
目的探讨应用Gn RH-a降调节及种植窗后移进行子宫内膜准备对反复种植失败患者妊娠结局的影响。方法回顾分析2016年1月-2017年1月在我中心诊断为反复种植失败并进行冻融胚胎激素替代移植(HRT)的139个周期。根据内膜准备方式及移植时间安排分为四组:A组:激素替代(n=31);B组:激素替代+种植窗后移(n=33);C组:降调节激素替代(n=42);D组:降调节激素替代+种植窗后移(n=33)。分析降调节及种植窗后移对妊娠结局的影响。结果四组患者移植日子宫内膜厚度、临床妊娠率、早期流产率均无统计学差异(P>0.05)。D组雌激素用药天数较长,与A组与B组相比,有显著性差异(P<0.05)。结论四种准备方案都可以使子宫内膜达到移植所需的条件。降调节组雌激素用量明显增加。反复种植失败患者没有发现绝对优势的内膜准备方案。
Objective:To investigate the effect of Gn RH-a down-regulation and implantation window backward protocols to the pregnancy outcomes of the repeated implantation failure patients. Methods:Retrospect analyze the 139 periods of the repeated implantation failure performing the thawed-frozen embryo hormone replacement transplantation from 2016/1 to 2017/1. Four groups were divided:hormone replacement(group A,n=31);hormone replacement + implantation window backward(group B,n=33);Gn RH-a down-regulation replacement(group C,n=42);Gn RH-a down-regulation replacement + implantation window backward(n=33). The effect of protocols to the pregnancy outcome were analyzed. Results:No significant differences of the thick of implantation endometria,clinical pregnancy rate,early abortion rate were found among the four groups. There is longer time of the estrogen using in the group D,significant difference was found between the group D and either group A or B(P<0.05). Conclusions:All of the four groups can make the endometria satisfied with the embryo implantation. Downregulation protocol increases the dose of estrogen using. No optimum protocol of the endometria preparing was found in the repeated implantation failure patients.
Objective:To investigate the effect of Gn RH-a down-regulation and implantation window backward protocols to the pregnancy outcomes of the repeated implantation failure patients. Methods:Retrospect analyze the 139 periods of the repeated implantation failure performing the thawed-frozen embryo hormone replacement transplantation from 2016/1 to 2017/1. Four groups were divided:hormone replacement(group A,n=31);hormone replacement + implantation window backward(group B,n=33);Gn RH-a down-regulation replacement(group C,n=42);Gn RH-a down-regulation replacement + implantation window backward(n=33). The effect of protocols to the pregnancy outcome were analyzed. Results:No significant differences of the thick of implantation endometria,clinical pregnancy rate,early abortion rate were found among the four groups. There is longer time of the estrogen using in the group D,significant difference was found between the group D and either group A or B(P<0.05). Conclusions:All of the four groups can make the endometria satisfied with the embryo implantation. Downregulation protocol increases the dose of estrogen using. No optimum protocol of the endometria preparing was found in the repeated implantation failure patients.
引文
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[10]张昀,熊芳,徐洪燕,肖潇,肖菊霞,周萍.激素替代-冻融胚胎移植周期子宫内膜的最佳容受时间研究[J].中国现代医学杂志,2017,27(06):54-58.
[2]Wang R,Wang F,Yang L,et al.Effects of Long-acting Gn RH-a prolonged protocol in assisted pregnancy via IVF-ET in infertile patients with PCOS[J].Minerva Chir,2018,[Epub ahead of print]
[3]Ding N,Liu X,Jian Q,et al.Dual trigger of final oocyte maturation with a combination of Gn RH agonist and h CG versus a h CG alone trigger in Gn RH antagonist cycle for in vitro fertilization:A Systematic Review and Meta-analysis[J].Eur J Obstet Gynecol Reprod Biol,2017,218:92-98.
[4]Tsai HW,Wang PH,Lin LT,et al.Using gonadotropin-releasing hormone agonist before frozen embryo transfer may improve ongoing pregnancy rates in hyperandrogenic polycystic ovary syndrome women[J].Gynecol Endocrinol,2017,33(9):686-689.
[5]Casper R F,Yanushpolsky E H.Optimal endometrial preparation for frozen embryo transfer cycles:window of implantation and progesterone support[J].Fertility&Sterility,2016,105(4):867-872.
[6]Sun L,Chen Z,Yin M,et al.Pregnancy and obstetric outcomes of fresh embryo transfer versus frozen-thawed embryo transfer in women below 35 years of age[J].Journal of Southern Medical University,2017:929-932.
[7]Flamigni C.Endometrial preparation for frozen-thawed embryo transfer with or without pretreatment with gonadotropin-releasing hormone agonist.[J].Fertility&Sterility,2002,77(5):956-960.
[8]Nalini M,Sharma S.The endometrium in assisted reproductive technology:How thin is thin?[J].J Hum Reprod Sci,2016,9(1):3-8.
[9]Bu Z,Wang K,Dai W,et al.Endometrial thickness significantly affects clinical pregnancy and live birth rates in frozen-thawed embryo transfer cycles[J].Gynecological Endocrinology,2016,32(7):524-528.
[10]张昀,熊芳,徐洪燕,肖潇,肖菊霞,周萍.激素替代-冻融胚胎移植周期子宫内膜的最佳容受时间研究[J].中国现代医学杂志,2017,27(06):54-58.