新疆医科大学学报

目的比较3种不同内膜准备方案在反复种植失败(RIF)患者再次冻融胚胎移植(FET)中的应用效果,旨在为RIF患者再次FET时选择合适内膜准备方案提供理论依据。方法回顾性分析2017年1月-2019年6月在新疆医科大学第一附属医院生殖医学中心行FET且年龄≤38岁的RIF患者158例共计256个FET周期临床资料,按照内膜准备方案分为3组:降调后人工周期组(GnRHa-AC组)93个周期、单纯人工周期组(AC组)74个周期及自然周期组(NC组)89个周期,比较3组患者一般资料、移植周期特点、妊娠结局及卫生经济学情况。结果 3组患者中GnRHa-AC组均未取消周期,AC组有3例取消周期,NC组有4例取消周期,纳入后续比较中GnRHa-AC组93个周期、AC组71个周期、NC组85个周期,3组患者一般资料及移植周期特点均无明显统计学差异(P>0.05)。GnRHa-AC组临床妊娠率、胚胎种植率、活产率均高于AC组及NC组,流产率均低于AC组及NC组,组间差异有统计学意义(P<0.05);NC组妊娠率、种植率及活产率略高于AC组,且流产率略低于AC组,但组间差异无统计学差异(P>0.05)。卫生经济学方面,GnRHa-AC组取消率低于后两组,操作性及可计划性均优于后两组。结论在反复种植失败患者再次冻融胚胎移植周期中,GnRHa-AC内膜准备方案可改善妊娠结局,同时因其取消率低、医患双方可计划性强,可能更加符合卫生经济学要求。

Objective To compare the application effects of three different endometrial preparation protocol in the frozen-thawed embryo transfer(FET) of RIF patients, and to provide theoretical basis for the selection of suitable endometrial preparation protocol in the case of RIF patients. Methods Retrospective analysisof clinical data of 158 RIFpatients with a total of 256 FET cycle from January 2017 to June 2019 was conducted,according to the endometrial preparation protocol,it was divided into three groups: artificial cycle after falling tone group(GnRHa-AC group) 93 cycles, pure artificial cycle group(AC group) 74 cycle and natural cycle group(NC group) 89 cycles, andgeneral data, transplant period, health economics and pregnancy outcomewere compared. Results Among the three groups, none of the patients in the GnRHa-AC group canceled the cycle, 3 patients in the AC group and 4 patients in the NC group were canceled.In the subsequent comparison, 93 cycles of the GnRHa-AC group, 71 of the AC group and 85 of the NC group were included.Cycle characteristics of three groups of patients with general information and transplantation had no significant statistical difference. The clinical pregnancy rate, embryo grow rate, and live birth rates in the GnRHa-AC groupwere higher than those in the AC and NC group, abortion ratewas lower than thatin the AC and NC group with statistical significance.The pregnancy rate, implant rate and live birth rate of the NC group were slightly higher than those of the AC group, and the abortion rate was slightly lower than that of the AC group, with no significant difference.In terms of health economics, the cancellation rate of the GnRHa-AC group was lower than that of the other two groups, and the operability and plannability of the GnRHa-AC group were better than those of the other two groups. Conclusion In the FET cycle of patients with RIF, the preparation protocol of GnRHa-AC can improve the pregnancy outcome and may be more in line with the requirements of health economics due to its low cancellation rate and strong planning ability of both doctors and patients.