本文關(guān)鍵詞： 激素補(bǔ)充周期 凍融胚胎移植 臨床妊娠結(jié)局 內(nèi)膜轉(zhuǎn)化日 回顧性研究　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:比較分析行激素補(bǔ)充周期—凍融胚胎移植(HRT—FET)治療后,患者不同臨床妊娠結(jié)局的影響因素,為不孕患者臨床指導(dǎo)提供科學(xué)依據(jù)。方法:回顧性分析2010年1月至2015年12月浙江大學(xué)醫(yī)學(xué)院附屬婦產(chǎn)科醫(yī)院因不孕行HRT—FET患者病例共6174個(gè)周期,其中包括每位研究對(duì)象的臨床、實(shí)驗(yàn)室及隨訪資料。按臨床妊娠結(jié)局陽(yáng)性及陰性分為兩組,通過(guò)單因素分析和二元logistic回歸分析比較行HRT—FET患者臨床妊娠結(jié)局的影響因素。探討在不同年份行HRT-FET患者臨床妊娠結(jié)局的差異性。比較分析HRT—FET內(nèi)膜轉(zhuǎn)化日血清雌孕激素水平對(duì)臨床妊娠結(jié)局的影響。結(jié)果:在納入本研究的6174個(gè)HRT—FET周期中,2586例(41.89%)臨床妊娠陽(yáng)性,3588例(58.11%)臨床妊娠陰性,兩組基礎(chǔ)特征間的女方年齡、男方年齡、不孕年限、基礎(chǔ)FSH水平、基礎(chǔ)FSH/LH比值、凍融胚胎移植數(shù)目等差異有統(tǒng)計(jì)學(xué)意義(P0.05)。以上研究因素進(jìn)行二元logistic回歸分析后發(fā)現(xiàn)女方年齡(OR= 0.979,95%CI:0.965～0.992,P=0.002)、不育年限(OR=0.978,95%CI:0.979～1.009,P=0.023)、基礎(chǔ) FSH/LH 比值(OR=0.877,95%CI:0.814～0.944,P=0.001)、凍融胚胎移植數(shù)目(OR=1.448,95%CI:1.328～1.579,P0.001)是 HRT—FET患者臨床妊娠是否成功的獨(dú)立影響因素。根據(jù)凍融胚胎移植年份分為6組,其中各組間取卵周期指標(biāo)(扳機(jī)日E2、扳機(jī)日P、取卵日內(nèi)膜厚度、成熟卵泡數(shù)、優(yōu)質(zhì)胚胎數(shù))以及凍融胚胎移植周期相關(guān)指標(biāo)(胚胎體外培養(yǎng)天數(shù)、凍融胚胎移植數(shù)目、內(nèi)膜轉(zhuǎn)化日內(nèi)膜厚度)差異均有統(tǒng)計(jì)學(xué)意義(P0.05),同時(shí)臨床妊娠率及胚胎種植率有顯著差異(P0.05)。根據(jù)內(nèi)膜轉(zhuǎn)化日血清雌激素水平分為三組,發(fā)現(xiàn)各組臨床妊娠率無(wú)顯著差異,僅內(nèi)膜轉(zhuǎn)化日內(nèi)膜厚度差異有顯著差異(.P0.05),內(nèi)膜轉(zhuǎn)化日血清雌激素水平與妊娠率呈負(fù)相關(guān)關(guān)系(r=-0.042),但不具有統(tǒng)計(jì)學(xué)意義(P0.05)。在對(duì)患者基礎(chǔ)特征匹配后共654個(gè)凍融單胚胎移植周期中,僅移植桑椹胚對(duì)臨床妊娠結(jié)局有顯著影響(P0.05)。結(jié)論:女方年齡、不育年限、基礎(chǔ)FSH/LH比值、凍融胚胎移植數(shù)目是預(yù)測(cè)患者HRT-FET臨床妊娠結(jié)局的獨(dú)立影響因素。在凍融胚胎移植數(shù)目逐年下降的情況下胚胎種植率呈逐年上升趨勢(shì)。內(nèi)膜轉(zhuǎn)化日血清雌激素水平對(duì)HRT-FET患者臨床妊娠結(jié)局無(wú)顯著影響。
[Abstract]:Objective: To compare the hormone replacement cycle for frozen thawed embryo transfer (HRT - FET) after treatment, the pregnancy outcome in patients with different clinical factors, to provide scientific basis for clinical guidance of patients with infertility. Methods: a retrospective analysis from January 2010 to December 2015 and affiliated medical college of Zhejiang University hospital for infertility underwent HRT - FET patients with 6174 cases each cycle, including clinical research object, laboratory and follow-up data. According to the clinical pregnancy outcome of positive and negative were divided into two groups by single factor analysis and logistic regression analysis of influencing factors of two yuan compared to HRT - FET in patients with clinical pregnancy outcome. To investigate the differences in clinical outcomes in HRT-FET patients of different years for comparative analysis of effect of HRT FET on endometrial transformation level of serum estrogen and progesterone on pregnancy outcomes in clinic. Results: included in the study of 6174 HRT - FET cycle, 2586 cases (41.89%) positive clinical pregnancy, 3588 cases of clinical pregnancy (58.11%) negative, the woman's age, two groups basic characteristics between male age, infertility duration, basal FSH level, FSH/LH ratio, the number of frozen thawed embryo transfer was statistically significant (P0.05). To study on the factors of two yuan logistic regression the analysis found that the woman's age (OR= 0.979,95%CI:0.965 ~ 0.992, P=0.002), duration of infertility (OR=0.978,95%CI:0.979 - 1.009, P=0.023), FSH/LH ratio (OR=0.877,95%CI:0.814 ~ 0.944, P=0.001), frozen thawed embryo transfer number (OR=1.448,95%CI:1.328 ~ 1.579, P0.001) is HRT - FET in patients with clinical pregnancy factors independent of success. According to the freezing effect thawed embryo transplantation years were divided into 6 groups, each group between oocyte cycle indicators (E2, P, trigger, trigger, take eggs, the endometrial thickness of mature egg number, the number of high-quality embryos) and frozen thawed embryo transfer Index cycle (embryos in vitro culture days, the number of frozen thawed embryo transfer, transformation on intima-media thickness of endometrium) showed significant differences (P0.05), and the clinical pregnancy rate and implantation rate were significantly different (P0.05). According to the transformation on endometrial estrogen level in serum were divided into three groups, each group found no significant difference in clinical pregnancy rate there is a significant difference, only on the transformation of endometrial endometrial thickness difference (.P0.05), endometrial transformation on serum estrogen level was negatively correlated with pregnancy rate (r=-0.042), but was not statistically significant (P0.05). In the matching of patients after a total of 654 basic characteristics of freezing and thawing single embryo transfer cycle, only a morula transplantation significant influence on the clinical outcome of pregnancy (P0.05). Conclusion: the age, duration of infertility, FSH/LH ratio, the number of frozen thawed embryo transfer were independent predictors of pregnancy outcome in patients with clinical HRT-FET. In frozen thawed embryo The rate of embryo implantation is increasing year by year. The level of serum estrogen has no significant effect on the clinical pregnancy outcome of HRT-FET patients.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.8

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本文編號(hào)：1474367