PCOS高雄激素血症患者降调节后行冻融胚胎移植的临床结局观察

摘要

目的 探讨降调节对多囊卵巢综合征(PCOS)高雄激素血症患者冻融胚胎移植(FET)周期临床结局的影响.方法 回顾性分析2012年1月至2016年4月在我院不孕不育科行FET的PCOS高雄激素血症患者139例的临床资料,根据内膜准备方案不同分为常规雌孕激素替代组(HRT组,n=76)和降调节雌孕激素替代组(降调节HRT组,n=63),观察两组患者雌激素使用时间和剂量、子宫内膜厚度及分型、血清激素水平及临床妊娠结局等.结果 两组患者的胚胎移植(ET)日子宫内膜厚度、移植胚胎数、优质胚胎率、早期流产率、异位妊娠率比较均无显著性差异(P>0.05);降调节HRT组补佳乐使用时间[(13.67±1.91) d]及总剂量[(81.55±10.80) mg]显著小于HRT组[分别为(15.28±2.47) d和(94.25±14.17) mg](P<0.01);降调节HRT组的ET日A型内膜占比(77.78%)、临床妊娠率(69.84%)及胚胎种植率(47.29%)均显著高于HRT组(分别为57.89%、51.31%、32.47%)(P<0.05).结论 对于PCOS高雄激素血症患者,降调节后雌孕激素替代法准备内膜可以减少雌激素使用时间及用量,改善子宫内膜分型,有效提高胚胎种植率和临床妊娠率.%Objective:To explore the influence of pituitary down-regulation on clinical outcomes of frozen-thawed embryo transfer cycles in patients with polycystic ovary syndrome (PCOS) and hyperandrogenism.Methods:A retrospective analysis was performed in 139 patients with PCOS and hyperandrogenism undergone frozen embryo transfer (FET) in the reproductive medicine center of Jiangsu Huai'an Maternity and Children Hospital from January 2012 to April 2016.The patients were divided to two groups according to the different endometrial preparation scheme:hormone replacement group (group A,n=76) and hormone replacement combined with pituitary down-regulation group (group B,n=63).The time and dose of estrogen use,endometrial thickness and type,serum hormone levels and clinical outcomes were compared between the two groups.Results:No significant differences were found in endometrial thickness on embryo transfer day,number of transferred embryos,quality embryo rate,early miscarriage rate and ectopic pregnancy rate between the two groups (P>0.05).The duration [(13.67±1.91) vs.(15.28±2.47) days] and dosage [(81.55±10.80) vs.(94.25±14.17) mg] of progynova used in group B was significantly less than group A (P<0.01).The type A endometrium on embryo transfer day (77.78% vs.57.89%),the clinical pregnancy rate (69.84% vs.51.31%)and implantation rate (47.29% vs.32.47%) in group B were significantly higher than group A (all P<0.05).Conclusions:Hormone replacement combined with pituitary down-regulation is an effective and convenient method for frozen-thawed embryo transfer cycles in patients with polycystic ovary syndrome and hyperandrogenism with less usage of estrogen,better classification of endometrium,higher pregnancy rate and embryo implantation rate.