本文選題：胚胎移植　切入點(diǎn)：激素替代療法　出處：《第二軍醫(yī)大學(xué)學(xué)報(bào)》2017年07期 　論文類型：期刊論文

【摘要】：目的探討改良超長(zhǎng)激素替代方案對(duì)既往胚胎種植失敗再行凍融胚胎移植(FET)患者妊娠結(jié)局的影響。方法選擇2015年1月至2017年1月于第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院生殖醫(yī)學(xué)中心體外受精/卵胞質(zhì)內(nèi)單精子注射-胚胎移植(IVF/ICSI-ET)著床失敗再次行FET的患者669例,根據(jù)本次FET周期子宮內(nèi)膜準(zhǔn)備方案分為2組:改良超長(zhǎng)激素組(n=184)患者接受改良超長(zhǎng)激素替代方案,單純激素組(n=485)患者接受單純激素替代方案。回顧性分析2種子宮內(nèi)膜準(zhǔn)備方案對(duì)患者妊娠結(jié)局的影響。結(jié)果 2組患者的年齡、體質(zhì)量指數(shù)、不孕年限、移植胚胎數(shù)、轉(zhuǎn)化日子宮內(nèi)膜厚度、移植日子宮內(nèi)膜厚度差異均無統(tǒng)計(jì)學(xué)意義(P0.05);改良超長(zhǎng)激素組的優(yōu)質(zhì)胚胎率低于單純激素組(50.9%vs 64.8%,P0.01),但囊胚移植率高于單純激素組(57.4%vs 18.3%,P0.01);改良超長(zhǎng)激素組胚胎著床率和臨床妊娠率均高于單純激素組,差異有統(tǒng)計(jì)學(xué)意義(29.8%vs 23.8%,46.7%vs 35.9%;P均0.05)。臨床妊娠的logistic多因素回歸分析提示,囊胚移植率和優(yōu)質(zhì)胚胎率是臨床妊娠的獨(dú)立影響因素。按照移植胚胎胎齡進(jìn)行的亞組分析結(jié)果顯示,卵裂期胚胎移植周期中,雖然單純激素組的優(yōu)質(zhì)胚胎率高于改良超長(zhǎng)激素組(67.5%vs 58.0%,P0.05),但兩組的胚胎著床率和臨床妊娠率差異均無統(tǒng)計(jì)學(xué)意義(23.0%vs 16.7%;34.9%vs 32.0%;P均0.05);在囊胚移植周期中,單純激素組與改良超長(zhǎng)激素組的優(yōu)質(zhì)胚胎率差異無統(tǒng)計(jì)學(xué)意義(52.7%vs 45.5%,P0.05),改良超長(zhǎng)激素組的胚胎著床率和臨床妊娠率均高于單純激素組(39.6%vs 27.2%,56.9%vs 40.2%;P均0.05)。結(jié)論對(duì)于既往胚胎種植失敗再次行FET助孕的不孕患者,改良超長(zhǎng)激素替代方案可提高胚胎著床率及臨床妊娠率,值得臨床推廣。
[Abstract]:Objective to investigate the effect of modified super-long hormone replacement protocol on pregnancy outcome in patients with frozen and thawed embryo transfer after failed embryo implantation. Methods from January 2015 to January 2017, reproductive medicine was selected in Changhai Hospital, second military Medical University. In vitro fertilization / intracytoplasmic sperm injection-embryo transfer (IVF / ICSI-ETT) implantation failed to perform FET again in 669 patients. According to the current FET cycle endometrial preparation program was divided into two groups: the modified super-long hormone group was treated with modified super-long hormone replacement regimen. The effects of two kinds of endometrial preparation regimen on pregnancy outcome were analyzed retrospectively. Results the age, body mass index, infertile years, number of embryos transferred in the two groups were analyzed retrospectively. The thickness of endometrium on the day of transformation, There was no significant difference in endometrial thickness on the day of transplantation; the rate of high quality embryos in the modified super long hormone group was lower than that in the simple hormone group (50.9 vs 64.8% P 0.01), but the blastocyst transfer rate was higher than that in the simple hormone group (57.4% vs 18.3% P 0.01); the embryo implantation rate and the impending rate in the modified super long hormone group were higher than those in the control group. The pregnancy rate in bed was higher than that in single hormone group. The difference was statistically significant (29.8 vs 23.8 vs 46.7 vs 35.9P). The multivariate logistic regression analysis showed that the rate of blastocyst transfer and the rate of high quality embryos were independent influencing factors of clinical pregnancy. The results of subgroup analysis according to the gestational age of transplanted embryos showed that the rate of blastocyst transfer and the rate of high quality embryos were independent factors of clinical pregnancy. In the cleavage embryo transfer cycle, although the rate of high quality embryos in the simple hormone group was higher than that in the modified super long hormone group (67.5 vs 58.0), there was no significant difference in embryo implantation rate and clinical pregnancy rate between the two groups (23.0 vs 16.734. 9 vs 32. 0% P 0. 05). In the blastocyst transfer cycle, there was no significant difference in embryo implantation rate and clinical pregnancy rate (P < 0. 05). There was no significant difference in the rate of high quality embryos between the simple hormone group and the modified super long hormone group. The embryo implantation rate and clinical pregnancy rate in the modified super long hormone group were higher than those in the simple hormone group (P < 0.05). Conclusion the embryo implantation rate and clinical pregnancy rate in the modified super long hormone group are higher than those in the simple hormone group (39.6 vs 27.2g / 56.9 vs 40.2%, P < 0.05). Conclusion for the former embryo species, the implantation rate and the clinical pregnancy rate of the modified super long hormone group are higher than those of the simple hormone group. The infertile patient who failed to receive FET to help pregnancy again, The modified super-long hormone replacement can increase embryo implantation rate and clinical pregnancy rate, which is worth popularizing.
【作者單位】： 第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院生殖醫(yī)學(xué)中心;
【分類號(hào)】：R714.8

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