芬吗通联合用药改善多囊卵巢综合征患者冻融胚胎移植周期子宫内膜血流及妊娠结局的研究

摘要

目的 探讨芬吗通不同给药方案对多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期子宫内膜血流及妊娠结局的影响.方法 选择2015年6月至2016年6月于山东中医药大学附属医院生殖与遗传中心接受冻融胚胎移植的PCOS患者为研究对象,随机分为补佳乐组(A组81个周期)、芬吗通口服组(B组78个周期)、芬吗通口服联合阴道给药组(C组86个周期),共245个周期,应用经阴道三维能量多普勒超声于黄体酮诱导内膜向分泌期转化日检测子宫内膜厚度及子宫内膜容积(V)、子宫内膜内血管化指数(VI)、血流指数(FI)、血管化血流指数(VFI),分析不同方案下内膜转化日雌激素水平、超声参数及临床妊娠率.结果 (1)3组患者诱导内膜向分泌期转化日子宫内膜厚度、容积,各组间比较差异无统计学意义(P>0.05);诱导内膜向分泌期转化日血流参数:VI、FI、VFI值C组较A组和B组高,差异有统计学意义(P<0.05);A组和B组组间比较,差异无统计学意义(P>0.05).(2)A组81个周期,移植79个周期;B组78个周期,移植77个周期;C组86个周期,移植85个周期.3组患者周期取消率、雌激素用药时间(至转化日)、诱导内膜向分泌期转化日P、LH水平、流产率各组间比较,差异无统计学意义(P>0.05);诱导内膜向分泌期转化日雌激素水平、着床率、临床妊娠率:C组高于A组和B组,差异有统计学意义(P<0.05),A组与B组组间比较,差异无统计学意义(P>0.05).结论 芬吗通口服联合阴道给药可明显增加体内雌激素水平,生物利用度高,能够促进子宫内膜内螺旋动脉的增生,增加子宫内膜血流,明显提高PCOS患者FET周期的着床率及临床妊娠率,是一种较理想的子宫内膜准备方案.%Objective:To study the effect of different schedule of Femoston in endometrial blood flow and pregnancy rate in frozen-thawed embryo transfer (FET) cycle in patients with polycystic ovary syndrome (PCOS).Methods:The 245 FET cycles of patients with PCOS in the center of affiliated hospital of Shandong university of TCM reproduction and genetic from June 2015 to June 2016 were collected.The patients were randomly divided into progynova group (group A,81 cycles) and Femoston oral group (group B,78 cycles) and Femonston oral combined vaginal group (group C,86 cycles).The endometrial thickness and volume,vascularization index (VI),flow index (FI),and vascularization flow index (VFI) were measured and serum E 2 levels were detected on the progesterone transformation day.Results:The endometrial thickness and volume on progesterone transformation day were not significantly different among the three groups (P>0.05).The VI,FI and VFI in group C were significantly higher than those in group A or group B (P<0.05),but there were not significantly different between group A and group B (P>0.05).There were 79 transplant cycles in 81 FET cycles in group A,77 transplant cycles in 78 FET cycles in group B,and 85 transplant cycles in 86 FET cycles in group C.The cycle cancellation rate,duration of estrogen used,the levels of progesterone and LH on the progesterone transformation day,and miscarriage rate were not significantly different among the three groups (P>0.05).The serum E 2 levels on the progesterone transformation day,the implantation rate,the clinical pregnancy rate in group C were significantly higher than those in group A and group B (P<0.05),but there were not significantly difference between group A and group B (P>0.05).Conclusions:Oral administration combined with vaginal administration of Femonston is an ideal endometrial preparation,because it can significantly increase the serum E 2 levels and bioavailability,and promote the endometrial spiral arteries hyperplasia & the endometrial blood flow,and improve the implantation rate and clinical pregnancy rate in FET cycle on patients with PCOS.