摘要
目的探讨不同子宫内膜准备方案和辅助生殖治疗前手术情况对子宫内膜异位症(内异症)相关性不孕患者冻融胚胎移植(FET)后妊娠结局的影响。方法回顾性分析行FET治疗的202例内异症相关性不孕患者的临床及随访资料,按不同内膜准备方案将患者分为降调节后激素替代周期组(143例)、激素替代周期组(22例)、促排周期组(16例)和自然周期组(21例);按辅助生殖治疗前是否行手术治疗将患者分为手术组(121例)、非手术组(81例),手术组和非手术组组内根据不同内膜准备方案再分别分为4个亚组。比较各组患者FET妊娠结局(早期流产率、临床妊娠率、多胎妊娠率、胚胎种植率、生化妊娠率、活产率)。结果(1)不同内膜准备方案组患者的早期流产率、临床妊娠率、多胎妊娠率、胚胎种植率、生化妊娠率、活产率差异均无统计学意义(均P>0.05)。(2)手术组与非手术组间的早期流产率、临床妊娠率、多胎妊娠率、胚胎种植率、生化妊娠率、活产率差异均无统计学意义(均P>0.05)。(3)非手术组中采用不同内膜准备方案患者的早期流产率差异有统计学意义(P<0.05),其中采用激素替代周期的患者早期流产率最低。(4)在促排周期组中,经手术治疗患者的早期流产率低于未经手术治疗的患者(P<0.05)。结论对于内异症相关性不孕患者,在FET中采用不同内膜准备方案的妊娠结局相似,且辅助生殖治疗前是否行手术治疗对妊娠结局没有显著影响,临床上可根据患者的实际情况、经济条件等选择最优方案。未经手术治疗的内异症相关性不孕患者采用激素替代周期行内膜准备方案可以降低早期流产率;内异症相关性不孕患者在使用促排周期行内膜准备前接受手术治疗可以降低早期流产率。
Objective To explore the effect of different endometrial preparation regimens and operation status before adjuvant reproductive therapy on pregnancy outcomes after frozen-thawed embryo transfer(FET)in patients with endometriosis associated infertility.Methods The clinical and follow-up data of 202 patients with endometriosis associated infertility who underwent FET therapy were retrospectively analyzed,and they were assigned to hormone replacement cycle after down-regulation group(143 cases),hormone replacement cycle group(22 cases),ovarian stimulation cycle group(16 cases),or natural cycle group(21 cases)according to different endometrial preparation regimens;in addition,patients were assigned to operation group(121 cases)or non-operation group(81 cases)according to whether surgical treatment before adjuvant reproductive therapy was performed or not,and the intragroups of the operation and non-operation groups were further assigned to 4 subgroups according to different endometrial preparation regimens.FET pregnancy outcomes with respect to early abortion rate,clinical pregnancy rate,multiple pregnancy rate,embryo implantation rate,biochemical pregnancy rate,and live birth rate in patients were compared between the various groups.Results(1)There was no statistically significant difference in early abortion rate,clinical pregnancy rate,multiple pregnancy rate,embryo implantation rate,biochemical pregnancy rate,and live birth rate between the various groups with different endometrial preparation regimens(all P>0.05).(2)No statistically significant difference in early abortion rate,clinical pregnancy rate,multiple pregnancy rate,embryo implantation rate,biochemical pregnancy rate,and live birth rate was found between the operation group and the non-operation group(all P>0.05).(3)There was a statistically significant difference in early abortion rate between the patients with different endometrial preparation regimens in the non-operation group(P<0.05),therein the lowest early abortion rate went to patients employing hormone replacement cycle.(4)Patients undergoing surgical treatment obtained a lower early abortion rate as compared with patients without surgical treatment in the ovarian stimulation cycle group(P<0.05).Conclusion Pregnancy outcomes of patients with endometriosis associated infertility employing different endometrial preparation regimens in FET are similar,whether surgical treatment is performed before adjuvant reproductive therapy or not exerts no significant impact on pregnancy outcomes,and the optimal regimen can be chosen according to practical status and economic conditions of patients in clinic.Patients with endometriosis associated infertility without surgical treatment employ hormone replacement cycle for endometrial preparation regimen can decrease the early abortion rate;moreover,patients with endometriosis associated infertility receive surgical treatment before employing ovarian stimulation cycle for endometrial preparation can decrease the early abortion rate.
作者
李淑欣
徐珉
LI Shuxin;XU Min(The Second Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou 510405,Guangdong,China;Department of Reproductive Medicine,Guangdong Hospital of Traditional Chinese Medicine,Guangzhou 510120,Guangdong,China)
出处
《广西医学》
CAS
2023年第4期396-402,共7页
Guangxi Medical Journal
基金
广东省中医院中医药科学技术研究专项项目(YN2019ML02)。
关键词
子宫内膜异位症
不孕症
冻融胚胎移植
内膜准备
手术治疗
妊娠结局
Endometriosis
Infertility
Frozen-thawed embryo transfer
Endometrial preparation
Surgical treatment
Pregnancy outcomes
