【摘要】：目的:探討凍胚移植失敗PCOS患者再次凍胚移植內(nèi)膜準(zhǔn)備的最佳方案。方法:回顧分析2011年8月~2013年7月在青島市婦女兒童醫(yī)院生殖中心行人工周期準(zhǔn)備內(nèi)膜凍融胚胎移植的PCOS患者的臨床資料,對(duì)移植失敗或因突破性出血取消周期尚有凍存胚胎的162例PCOS患者實(shí)施再次凍胚移植。將患者隨機(jī)分為GnRHa+人工周期(降調(diào)節(jié)+人工周期組)、人工周期和誘導(dǎo)排卵方案3組,觀察3組患者的年齡、體重指數(shù)(BMI)、不孕年限、胚胎凍存時(shí)間、突破性出血率、周期取消率、優(yōu)質(zhì)胚胎率、移植胚胎數(shù)、移植日子宮內(nèi)膜厚度及類型、內(nèi)膜增殖時(shí)間、內(nèi)膜轉(zhuǎn)化日血清雌激素濃度、種植率、妊娠率、流產(chǎn)率、異位妊娠率。結(jié)果:降調(diào)節(jié)+人工周期組和誘導(dǎo)排卵組無(wú)一例發(fā)生突破性出血。誘導(dǎo)排卵組內(nèi)膜轉(zhuǎn)化日E2平均水平為(2827.33±1148.49)pg/ml,高于其他2組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);平均子宮內(nèi)膜厚度為(9.14±0.90)mm,較其他2組增高,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。誘導(dǎo)排卵組的B級(jí)以下內(nèi)膜所占比例最低,為9.76%,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。降調(diào)節(jié)+人工周期組的臨床妊娠率和著床率分別為50.94%和22.54%,誘導(dǎo)排卵組分別為53.66%和22.77%,與人工周期組(31.03%,13.07%)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:對(duì)于PCOS患者,初次凍胚移植失敗后再次凍胚移植時(shí)采用降調(diào)節(jié)+人工周期方案或誘導(dǎo)排卵方案,可降低突破性出血率,減少周期取消,提高妊娠率和著床率。
[Abstract]:Objective: to explore the best method for preparing the endometrium of frozen embryo transplantation (PCOS) in patients with failed frozen embryo transplantation. Methods: the clinical data of PCOS patients undergoing artificial cycle preparation for frozen-thawed embryo transfer in the reproductive center of Qingdao Women and Children Hospital from August 2011 to July 2013 were retrospectively analyzed. Frozen embryo transfer was performed in 162 patients with PCOS who failed in transplantation or whose embryo was frozen due to the cancellation of breakthrough hemorrhage. The patients were randomly divided into three groups: GnRHa artificial cycle group, artificial cycle group and induced ovulation group. The age, body mass index (BMI),) infertility, embryo cryopreservation time, breakthrough bleeding rate and cycle cancellation rate were observed. The rate of high quality embryos, the number of embryos transferred, the thickness and type of endometrium on the day of transplantation, the time of endometrial proliferation, the concentration of serum estrogen, implantation rate, pregnancy rate, abortion rate and ectopic pregnancy rate on the day of endometrial transformation. Results: no breakthrough hemorrhage occurred in the artificial cycle group and ovulation induction group. The average level of E _ 2 was (2827.33 鹵1148.49) pg/ml, in the ovulatory group and (9.14 鹵0.90) mm, in the other two groups (P0.05), but the difference was not significant (P0.05). The proportion of subgrade B endometrium in ovulation induction group was the lowest (9.76%), but the difference was not statistically significant (P0.05). The clinical pregnancy rate and implantation rate were 50.94% and 22.54% in the artificial cycle group, 53.66% and 22.77% in the induced ovulation group, respectively, which were significantly different from those in the artificial cycle group (31.03%, 13.07%) (P0.05). Conclusion: for patients with PCOS, artificial cycle or ovulation induction regimen can decrease the rate of breakthrough bleeding, reduce cycle cancellations, and increase pregnancy rate and implantation rate.
【作者單位】： 青島市婦女兒童醫(yī)院生殖中心;鄭州大學(xué)第一附屬醫(yī)院生殖中心;
【分類號(hào)】：R714.8

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