本文選題：凍融胚胎移植 + 薄型子宮內(nèi)膜　； 參考：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:近年來(lái),體外受精-胚胎移植(IVF-ET)已發(fā)展成為生殖醫(yī)學(xué)的重要組成部分。雖然IVF-ET技術(shù)在不斷的改進(jìn)和更新,目前已獲得滿意的成功率,但仍然存在一些問(wèn)題,比如著床率低、周期取消率高等,出現(xiàn)這些問(wèn)題的原因主要有胚胎質(zhì)量問(wèn)題及內(nèi)膜的容受性等。子宮內(nèi)膜的容受性影響著受精卵的著床,子宮內(nèi)膜生長(zhǎng)不良是導(dǎo)致胚胎移植失敗的重要因素。對(duì)于IVF-ET,合適的子宮內(nèi)膜環(huán)境是胚胎移植成功的必備條件。目前越來(lái)越多的患者因子宮內(nèi)膜薄,從而取消移植周期。薄型子宮內(nèi)膜屬中醫(yī)學(xué)無(wú)子、月經(jīng)過(guò)少、閉經(jīng)等范疇,腎虛、血瘀是其基本病機(jī)。基于中醫(yī)學(xué)這一基本理論,本研究觀察補(bǔ)腎活血周期療法對(duì)薄型子宮內(nèi)膜患者的冷凍胚胎移植的臨床療效,并探討補(bǔ)腎活血周期療法的作用機(jī)理,以期改善薄型子宮內(nèi)膜的血流灌注,改善子宮內(nèi)膜的容受性,提高薄型子宮內(nèi)膜患者的冷凍胚胎移植(FET)著床率,或降低冷凍胚胎移植的周期取消率。方法:本研究的研究對(duì)象均為在2016年1月至2016年12月就診于廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院婦科門診、廣東省第二人民醫(yī)院生殖中心不孕不育中醫(yī)門診,采用人工周期替代方案準(zhǔn)備內(nèi)膜的薄型子宮內(nèi)膜FET患者共40例,隨機(jī)分為兩組:(中藥+補(bǔ)佳樂(lè))治療組和補(bǔ)佳樂(lè)對(duì)照組。(中藥+補(bǔ)佳樂(lè))治療組:排卵前,服用理氣活血補(bǔ)腎中藥方+補(bǔ)佳樂(lè)。排卵后至抽血HCG日,服用溫腎活血中藥方+補(bǔ)佳樂(lè)。補(bǔ)佳樂(lè)對(duì)照組:排卵前至抽血HCG日一直服用補(bǔ)佳樂(lè)。兩組均治療一個(gè)周期。觀察治療前后兩組移植前陰道超聲下子宮內(nèi)膜厚度、子宮血流動(dòng)力學(xué)(RI)、D二聚體的變化,以及兩組妊娠率、可移植病例率的情況。成果:1.兩組治療前后的移植前陰道超聲下子宮內(nèi)膜厚度變化進(jìn)行比較均有顯著性差異(P0.05),治療組在內(nèi)膜改善方面優(yōu)于對(duì)照組(P0.05)。2.治療組治療前后子宮血流動(dòng)力學(xué)(RI)、D二聚體的變化進(jìn)行比較均有顯著性差異(P0.05)。3.兩組可移植病例率比較有顯著性差異(P0.05)。結(jié)論:1.補(bǔ)腎活血周期療法有助于提高子宮內(nèi)膜厚度。2.補(bǔ)腎活血周期療法可改善子宮血流動(dòng)力學(xué)。3.補(bǔ)腎活血周期療法可降低冷凍胚胎移植的周期取消率。
[Abstract]:Objective: in recent years, IVF-ETS has become an important part of reproductive medicine. Although IVF-ET technology has been continuously improved and updated, it has achieved a satisfactory success rate, but there are still some problems, such as low implantation rate, high cycle cancellation rate, etc. The main causes of these problems are embryo quality and endometrial receptivity. Endometrial receptivity affects the implantation of fertilized eggs. Endometrial malgrowth is an important factor leading to the failure of embryo transfer. For IVF-ETs, an appropriate endometrial environment is a prerequisite for successful embryo transfer. At present, more and more patients cancel the transplant cycle because of the thin endometrium. Thin endometrium belongs to traditional Chinese medicine, menstruation, amenorrhea and other categories, kidney deficiency, blood stasis is its basic pathogenesis. Based on the basic theory of traditional Chinese medicine, this study observed the clinical effect of tonifying kidney and activating blood cycle therapy on frozen embryo transfer in patients with thin endometrium, and discussed the mechanism of cycle therapy of tonifying kidney and activating blood circulation. In order to improve the blood flow perfusion of thin endometrium, improve the receptivity of endometrium, increase the implantation rate of frozen embryo transfer (FET) in patients with thin endometrium, or reduce the rate of cycle cancellation of frozen embryo transfer. Methods: from January 2016 to December 2016, the subjects of this study were the gynecological outpatient clinic of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, and the infertility clinic of the Reproductive Center of the second people's Hospital of Guangdong Province. A total of 40 patients with FET of thin endometrium prepared by artificial cycle replacement were randomly divided into two groups: one was treated with Bu Jia Le and the other was treated with Bujialao. Treatment group: before ovulation, take Qi Huoxue tonifying Kidney prescription Bu Jia Le. After ovulation until HCG day, take warm kidney and blood circulation prescription Bujia Le. Bujialao control group: Bujialao was taken before ovulation until the day of HCG. Both groups were treated for one cycle. The changes of endometrial thickness, uterine hemodynamics, RII-D dimer, pregnancy rate and transplantable cases were observed before and after treatment. Result: 1. There was significant difference in endometrial thickness between the two groups before and after the treatment. The treatment group was better than the control group in improving the endometrium. In the treatment group, there were significant differences in the changes of RII-D dimer in uterine hemodynamics before and after treatment. There was significant difference between the two groups in the rate of transplantable cases (P 0.05). Conclusion 1. The treatment of tonifying kidney and activating blood circulation helps to increase the thickness of endometrium. The treatment of tonifying kidney and activating blood circulation can improve uterine hemodynamics. The cycle therapy of tonifying kidney and activating blood circulation can reduce the cycle canceling rate of frozen embryo transfer.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(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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