【摘要】：目的探討低分子肝素(LMWH)、生長激素(GH)應(yīng)用于反復(fù)種植失敗(RIF)患者再次行體外受精-胚胎移植助孕時(shí),對(duì)其助孕過程及妊娠結(jié)局有無影響,并對(duì)比其應(yīng)用效果。方法本研究采用前瞻性的研究方法,對(duì)2015年6月~2017年2月就診于唐山市婦幼保健院生殖遺傳科多次(≥3個(gè)周期,包括解凍周期)行體外受精胚胎移植失敗而再次行新鮮周期胚胎移植的不孕患者124周期進(jìn)行研究。隨機(jī)將符合條件的研究對(duì)象分為常規(guī)組42周期、LMWH組41周期、GH組41周期。比較各組獲卵數(shù)、MII數(shù)、優(yōu)質(zhì)胚胎數(shù)、優(yōu)質(zhì)胚胎率;比較HCG日內(nèi)膜厚度及A/B型內(nèi)膜比例;比較生化妊娠率、胚胎種植率、臨床妊娠率。并比較三組患者中年齡35歲的周期、≥35歲的周期分別所對(duì)應(yīng)的妊娠結(jié)局;比較三組患者中考慮無血栓前狀態(tài)的周期、有血栓前狀態(tài)的周期分別所對(duì)應(yīng)的妊娠結(jié)局,以探究LMWH、GH在RIF患者中的應(yīng)用價(jià)值并比較兩藥效果的差異性。結(jié)果1三組患者的年齡、不孕年限、BMI、AFC、bFSH、bE2、血栓前狀態(tài)率比相比較無統(tǒng)計(jì)學(xué)差異(P0.05);三組患者的促排卵情況中Gn天數(shù)、Gn用量、HCG日E2對(duì)比無統(tǒng)計(jì)學(xué)差異(P0.05);三組患者胚胎情況中的獲卵數(shù)、MII卵數(shù)、優(yōu)質(zhì)胚胎數(shù)、優(yōu)質(zhì)胚胎率相比無統(tǒng)計(jì)學(xué)差異(P0.05);三組患者的凝血系列TT、APTT、PT、FIB及D-二聚體(D-Di)相比無統(tǒng)計(jì)學(xué)差異(P0.05)。2三組患者HCG日內(nèi)膜厚度、A/B型內(nèi)膜比例無統(tǒng)計(jì)學(xué)差異(P0.05)。3 LMWH組的生化妊娠率相較于常規(guī)組明顯增高,差異有統(tǒng)計(jì)學(xué)意義(P0.017),LMWH組的生化妊娠率與GH組相比較,差異無統(tǒng)計(jì)學(xué)意義(P0.017),常規(guī)組的生化妊娠率相較于GH組差異無統(tǒng)計(jì)學(xué)意義(P0.017);三組患者的胚胎種植率、臨床妊娠率差異無統(tǒng)計(jì)學(xué)意義(P0.05)。4三組患者中年齡35歲的周期,其胚胎種植率、臨床妊娠率均無顯著性差異(P0.05),三組患者中年齡≥35歲的周期其胚胎種植率、臨床妊娠率有所升高,但無顯著性差異(P0.05)。5三組中考慮無血栓前狀態(tài)的周期,其組間的胚胎種植率、臨床妊娠率均無顯著性差異(P0.05);三組中考慮為血栓前狀態(tài)的周期,三組間胚胎種植率無顯著差異(P0.05),LMWH組的臨床妊娠率相較于常規(guī)組明顯增高,差異具有顯著性(P0.017),LMWH組的臨床妊娠率相較于GH組相比較無顯著性差異(P0.017),常規(guī)組與GH組的臨床妊娠率相比較無顯著性差異(P0.017)。結(jié)論1低分子肝素對(duì)于有血栓前狀態(tài)的RIF患者有明顯的助孕益處,可提高其臨床妊娠率,應(yīng)用具有安全性,可考慮作為具有高凝狀態(tài)反復(fù)種植失敗者的輔助用藥。2生長激素對(duì)于病因欠確切的RIF患者受益或并不明顯。3反復(fù)種植失敗的病因復(fù)雜,加強(qiáng)病因?qū)W篩查的同時(shí),用藥的選擇也應(yīng)強(qiáng)調(diào)個(gè)體化。
[Abstract]:Objective to investigate the effect of low molecular weight heparin (LMWH) (LMWH), growth hormone (GH) (LMWH (GH) on the pregnancy aid process and pregnancy outcome in patients with repeated failed (RIF) during in vitro fertilization and embryo transfer (IVF). Methods in this study, prospective research methods were used to study the reproductive genetics department of Tangshan Maternal and Child Health Hospital from June 2015 to February 2017. The study was conducted on 124 cycles of infertile patients undergoing in vitro fertilization and embryo transfer, including thawing cycles, and repeated fresh cycle embryo transfer. The subjects were randomly divided into normal group (42 cycles), LMWH group (41 cycles) and GH group (41 cycles). The number of eggs, MII, the rate of high quality embryos, the thickness of intima and the ratio of type A / B intima of HCG, the rate of biochemical pregnancy, the rate of embryo implantation and the rate of clinical pregnancy were compared. The pregnancy outcomes of the three groups were compared between the cycles of 35 years old and the cycles of 鈮，

本文編號(hào)：2375517