摘要/Abstract
摘要： 目的 ·探讨行冻融胚胎移植（ frozen-thawed embryo transfer，FET）过程中影响子宫内膜异位症（ endometriosis，EMT）患者妊娠结局的因素，为 EMT患者临床选择 FET策略提供参考。方法 ·回顾分析 2015年 1月—2017年 12月在中国人民解放军联勤保障部队第九○○医院妇产科生殖医学中心行囊胚 FET的 EMT患者共 329例，按内膜准备方案将患者分为促性腺激素释放激素激动剂降调节后激素替代周期组（ A1组，138例）、激素替代周期组（ B1组，52例）和自然周期组（ C1组，139例），按年龄将其分为 < 30岁组（ A2组，109例）、 30～ 35岁组（ B2组，161例）和 > 35岁组（ C2组，59例），以及按孕激素转化日子宫内膜厚度将其分为 <9 mm组（A3组，111例）、 9～ 12 mm组（B3组，181例）和 > 12 mm组（C3组，37例）。分别于不同因素分组下，比较各组 EMT患者囊胚 FET妊娠结局间的差异。结果 ·依内膜准备方案分组， A1组患者的内膜厚度显著大于 B1组（P0.041），B1组患者的种植率和临床妊娠率均显著高于 C1组（P0.000，P0.003）；与 A1组相比， B1组患者的种植率较高（ P0.023），C1组则较低（ P0.027）。依年龄分组， A2组患者的流产率显著高于 B2组（P0.007）。依孕激素转化日子宫内膜厚度分组，与 A3组相比， B3组患者的种植率较高（P0.041），而 C3组则较低（ P0.026）。结论 ·激素替代周期内膜准备方案可提高 EMT患者囊胚 FET的种植率和临床妊娠率，降低流产率和异位妊娠率。该方案可能是临床上较为经济、高效的内膜准备方案。
关键词: 子宫内膜异位症, 冻融胚胎移植, 内膜准备, 促性腺激素释放激素激动剂, 降调节, 激素替代周期
Abstract:
Objective · To explore the factors affecting the pregnancy outcome of frozen-thawed embryo transfer (FET) in endometriosis (EMT) patients into provide reference for the clinical selection of FET strategies. Methods · A total of 329 EMT patients who received blastocyst FET at the Reproductive Medicine Center, Department of Obstetrics & Gynecology, The 900th Hospital of the Joint Logistics Support Force, PLA, Jan. 2015 to Dec. 2017 were analyzed retrospectively. The patients were divided into three groups according to endometrial preparation protocols, ages, and endometrial thickness on the day of progesterone conversion, respectively.endometrial preparation protocols, the three groups included gonadotropinreleasing hormone agonist (GnRH-a) down-regulation+ hormone replacement therapy (HRT) group (GnRH-a+HRT group, A1 group, n138), HRT group (B1 group, n52), and natural cycle (NC) group (C1 group, n139).ages, the three groups included <30 years old group (A2 group, n109), 30-35 years old group (B2 group, n161), and >35 years old group (C2 group, n59).endometrial thickness on the day of progesterone conversion, the three groups included <9 mm group (A3 group, n111), 9-12 mm group (B3 group, n181), and >12 mm group (C3 group, n37). The differences in pregnancy outcomes among EMT patients with blastocyst FET were compared under different grouping factors. Results · The endometrium of A1 group was significantly thicker than thatof B1 group (P0.041), the implantation rate and clinical pregnancy rate of B1 group weresignificantly higherthanthose of C1 group (P0.000, P0.003). Compared with A1 group, the implantation rate of B1 group was significantly higher (P0.023), while it was significantly lower in group C1 (P0.027). The abortion rate of A2 group was significantly higher than that of B2 group (P0.007). Compared with A3 group, the implantation rate of B3 group was significantly higher (P0.041), while it was significantly lower in C3 group (P0.026). Conclusion · HRT endometrial preparation protocol for EMT patients with blastocyst FET can improve the implantation rate and clinical pregnancy rate, and reduce the abortion rate and ectopic pregnancy rate, which maybe an economicalandefficient endometrial preparation protocol inclinical.
Key words: endometriosis (EMT), frozen-thawed embryo transfer (FET), endometrial preparation, gonadotropin-releasing hormone agonist (GnRH-a), down-regulation, hormone replacement therapy (HRT)
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