自然周期冻融胚胎移植中不同孕酮转化内膜时间临床结局分析
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摘要
目的:探讨自然周期冻融胚胎移植(FET)中不同孕酮转化内膜时间对临床结局的影响。方法:回顾分析2014年1月至2018年7月于河南省人民医院生殖中心行自然周期冻融胚胎移植共891个周期的临床结局。根据孕酮转化内膜时间不同将其分为2-3组(孕酮转化子宫内膜2天后移植D3胚胎,n=506)、3-3组(孕酮转化子宫内膜3天后移植D3胚胎,n=172)、4-5组(孕酮转化子宫内膜4天后移植囊胚,n=115)和5-5组(孕酮转化子宫内膜5天后移植囊胚,n=98),比较各组基础指标和临床结局相关指标。结果:2-3组和3-3组,4-5组和5-5组患者的一般情况比较,差异均无统计学意义(P>0.05)。2-3组、3-3组、4-5组和5-5组的种植率分别为40.54%(390/962)、43.77%(144/329)、74.19%(115/155)和62.20%(79/127),临床妊娠率分别为57.71%(292/506)、58.72%(101/172)、80.87%(93/115)和70.41%(69/98),异位妊娠率分别为4.45%(13/292)、0(0/101)、0(0/93)和2.90%(2/69),早期流产率分别为9.25%(27/292)、5.94%(6/101)、12.90%(12/93)和4.35%(3/69),持续妊娠率分别为52.37%(265/506)、55.23%(95/172)、70.43%(81/115)和67.35%(66/98)。2-3组和3-3组、4-5组和5-5组的种植率、临床妊娠率、异位妊娠率、早期流产率、持续妊娠率比较,差异均无统计学意义(P>0.05)。结论:自然周期FET中孕酮转化子宫内膜2～3天移植第3天卵裂期胚胎,孕酮转化子宫内膜4～5天移植囊胚均可获得满意的临床结局,临床工作中可以根据医院工作安排及患者的情况进行灵活调整。
Objective:To investigate the clinical outcome of natural cycle frozen-thawed embryo transfers in different endometrial progesterone preparation time.Methods:From Jan.2014 to Jul.2018,a total of 891 frozen-thawed embryo transfer cycles using natural cycle endometrial preparation scheme were studied retrospectively in Reproductive Medical Center of Henan Provincial People's Hospital.It was divided into 4 groups according to the duration of endometrial progesterone preparation:group 2-3(2 days after endometrial progesterone preparation and transfer D3 embryo,n=506),group 3-3(3 days after endometrial progesterone preparation and transfer D3 embryo,n=172), group 4-5(4 days after endometrial progesterone preparation and transfer D5 blastocyst,n=115),group 5-5(5 days after endometrial progesterone preparation and transfer D5 blastocyst,n=98),the base data and clinical outcomes were compared among those groups.Results:The general characteristics had no significant difference comparing between 2-3 group and 3-3 group,4-5 group and 5-5 group(P>0.05).The implantation rate of group 2-3 group 3-3 group 4-5 and group 5-5 were 40.54%(390/962),43.77%(144/329),74.19%(115/155) and 62.20%(79/127),respectively.The clinical pregnancy rate of group 2-3 group 3-3 group 4-5 and group 5-5 were 57.71%(292/506),58.72%(101/172),80.87%(93/115) and 70.41%(69/98),respectively.The ectopic pregnancy rate of group 2-3 group 3-3 group 4-5 and group 5-5 were 4.45%(13/292),0(0/101),0(0/93) and 2.90%(2/69).The early abortion rate of group 2-3 group 3-3 group 4-5 were 9.25%(27/292),5.94%(6/101),12.90%(12/93) and 2.90%(2/69),respectively.The ongoing pregnancy rate of group 2-3 group 3-3 group 4-5 group 5-5 were 52.37%(265/506),5.94%(6/101),70.43%(81/115) and 67.35%(66/98),respectively.The clinical pregnancy rate,the implantation rate,the ectopic pregnancy rate,the early abortion rate and the ongoing pregnancy rate had no significant difference in comparing between group 2-3 and group 3-3,group 4-5 and group 5-5(P>0.05).Conclusions:The clinical outcomes of D3 embryo transfer in 2 or 3 days of progesterone transformed endometrium and D5 blastocysts transfer in 4 or 5 days of progesterone transformed endometrium are comparable.
Objective:To investigate the clinical outcome of natural cycle frozen-thawed embryo transfers in different endometrial progesterone preparation time.Methods:From Jan.2014 to Jul.2018,a total of 891 frozen-thawed embryo transfer cycles using natural cycle endometrial preparation scheme were studied retrospectively in Reproductive Medical Center of Henan Provincial People's Hospital.It was divided into 4 groups according to the duration of endometrial progesterone preparation:group 2-3(2 days after endometrial progesterone preparation and transfer D3 embryo,n=506),group 3-3(3 days after endometrial progesterone preparation and transfer D3 embryo,n=172), group 4-5(4 days after endometrial progesterone preparation and transfer D5 blastocyst,n=115),group 5-5(5 days after endometrial progesterone preparation and transfer D5 blastocyst,n=98),the base data and clinical outcomes were compared among those groups.Results:The general characteristics had no significant difference comparing between 2-3 group and 3-3 group,4-5 group and 5-5 group(P>0.05).The implantation rate of group 2-3 group 3-3 group 4-5 and group 5-5 were 40.54%(390/962),43.77%(144/329),74.19%(115/155) and 62.20%(79/127),respectively.The clinical pregnancy rate of group 2-3 group 3-3 group 4-5 and group 5-5 were 57.71%(292/506),58.72%(101/172),80.87%(93/115) and 70.41%(69/98),respectively.The ectopic pregnancy rate of group 2-3 group 3-3 group 4-5 and group 5-5 were 4.45%(13/292),0(0/101),0(0/93) and 2.90%(2/69).The early abortion rate of group 2-3 group 3-3 group 4-5 were 9.25%(27/292),5.94%(6/101),12.90%(12/93) and 2.90%(2/69),respectively.The ongoing pregnancy rate of group 2-3 group 3-3 group 4-5 group 5-5 were 52.37%(265/506),5.94%(6/101),70.43%(81/115) and 67.35%(66/98),respectively.The clinical pregnancy rate,the implantation rate,the ectopic pregnancy rate,the early abortion rate and the ongoing pregnancy rate had no significant difference in comparing between group 2-3 and group 3-3,group 4-5 and group 5-5(P>0.05).Conclusions:The clinical outcomes of D3 embryo transfer in 2 or 3 days of progesterone transformed endometrium and D5 blastocysts transfer in 4 or 5 days of progesterone transformed endometrium are comparable.
引文
[1] Groenewoud ER,Cohlen BJ,Macklon NS.Programming the endometrium for deferred transfer of cryopreserved embryos:hormone replacement versus modified natural cycles[J].Fertil Steril,2018,109(5):768-774
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[4] Groenewoud ER,Kollen BJ,Macklon NS,et al.Spontaneous LH surges prior to hCG administration in unstimulated-cycle frozen-thawed embryo transfer do not influence pregnancy rates[J].Reprod Biomed Online,2012,24(2):191-196
[5] Irani M,Robles A,Gunnala V,et al.Optimal parameters for determining the LH surge in natural cycle frozen-thawed embryo transfers[J].J Ovarian Res,2016,106(3):e143-e143
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[7] 乔岩岩,张俊博,侯高林,等.不同子宫内膜准备方案的冻融胚胎移植临床结局比较[J].中国优生与遗传杂志,2018,26(8):118-120
[8] 王贞静,孙梅,秦莹莹,等.人绒毛膜促性腺激素对自然周期冻融囊胚移植妊娠结局的影响[J].现代妇产科进展,2018,27(1):54-56
[9] Bergh PA,Navot D.The impact of embryonic development and endometrial maturity on the timing of implantation Presented at the 46th Annual Meeting of the American Fertility Society,Washington,DC,October 15 to 18,1990[J].Fertil Steril,1992,58(3):537-542
[10] Agha-Hosseini M,Hashemi L,Aleyasin A,et al.Natural cycle versus artificial cycle in frozen-thawed embryo transfer:A randomized prospective trial[J].Turk J Obstet Gynecol,2018,15(1):12-17
[11] Coutifaris C,Myers ER,Guzick DS,et al.Histological dating of timed endometrial biopsy tissue is not related to fertility status[J].Fertil Steril,2004,82(5):1264-1272
[12] Diaz-Gimeno P,Horcajadas JA,Martinez-Conejero JA,et al.A genomic diagnostic tool for human endometrial receptivity based on the transcriptomic signature[J].Fertil Steril,2011,95(1):50-60
[13] Edgell TA,Rombauts LJF,Salamonsen LA.Assessing receptivity in the endometrium:the need for a rapid,non-invasive test[J].Reprod BioMed Online,2013,27(5):486-496
[14] 董哲,孙玲,陈志恒,等.以孕酮水平确定冻融胚胎移植时间的临床研究[J].生殖医学杂志,2016,25(1):11-15
[15] 方春霞,朱琴,张红霞,等.孕酮测定在决定自然周期冷冻胚胎移植时机中的价值[J].中国妇幼保健,2017,32(13):2991-2993
[16] 路锦,张翠莲,张少娣,等.冻融胚胎移植中孕酮转化子宫内膜时间对妊娠结局的影响[J].中华妇产科杂志,2014,49(6):424-427
[2] Kupka M,Dhooghe T,Ferraretti AP,et al.Assisted reproductive technology in Europe,2011:results generated from European registers by ESHRE[J].Hum Reprod,2016,31(2):233-248
[3] Groenewoud ER,Cohlen BJ,Al-Oraiby A,et al.A randomized controlled,non-inferiority trial of modified natural versus artificial cycle for cryo-thawed embryo transfer[J].Hum Reprod,2016,31(7):1483-1492
[4] Groenewoud ER,Kollen BJ,Macklon NS,et al.Spontaneous LH surges prior to hCG administration in unstimulated-cycle frozen-thawed embryo transfer do not influence pregnancy rates[J].Reprod Biomed Online,2012,24(2):191-196
[5] Irani M,Robles A,Gunnala V,et al.Optimal parameters for determining the LH surge in natural cycle frozen-thawed embryo transfers[J].J Ovarian Res,2016,106(3):e143-e143
[6] Huang P,Wei L,Li X.Modified hMG stimulated an effective option in endometrial preparation for frozen-thawed embryo transfer in patients with normal menstrual cycles[J].Gynecol Endocrinol,2018:1-3
[7] 乔岩岩,张俊博,侯高林,等.不同子宫内膜准备方案的冻融胚胎移植临床结局比较[J].中国优生与遗传杂志,2018,26(8):118-120
[8] 王贞静,孙梅,秦莹莹,等.人绒毛膜促性腺激素对自然周期冻融囊胚移植妊娠结局的影响[J].现代妇产科进展,2018,27(1):54-56
[9] Bergh PA,Navot D.The impact of embryonic development and endometrial maturity on the timing of implantation Presented at the 46th Annual Meeting of the American Fertility Society,Washington,DC,October 15 to 18,1990[J].Fertil Steril,1992,58(3):537-542
[10] Agha-Hosseini M,Hashemi L,Aleyasin A,et al.Natural cycle versus artificial cycle in frozen-thawed embryo transfer:A randomized prospective trial[J].Turk J Obstet Gynecol,2018,15(1):12-17
[11] Coutifaris C,Myers ER,Guzick DS,et al.Histological dating of timed endometrial biopsy tissue is not related to fertility status[J].Fertil Steril,2004,82(5):1264-1272
[12] Diaz-Gimeno P,Horcajadas JA,Martinez-Conejero JA,et al.A genomic diagnostic tool for human endometrial receptivity based on the transcriptomic signature[J].Fertil Steril,2011,95(1):50-60
[13] Edgell TA,Rombauts LJF,Salamonsen LA.Assessing receptivity in the endometrium:the need for a rapid,non-invasive test[J].Reprod BioMed Online,2013,27(5):486-496
[14] 董哲,孙玲,陈志恒,等.以孕酮水平确定冻融胚胎移植时间的临床研究[J].生殖医学杂志,2016,25(1):11-15
[15] 方春霞,朱琴,张红霞,等.孕酮测定在决定自然周期冷冻胚胎移植时机中的价值[J].中国妇幼保健,2017,32(13):2991-2993
[16] 路锦,张翠莲,张少娣,等.冻融胚胎移植中孕酮转化子宫内膜时间对妊娠结局的影响[J].中华妇产科杂志,2014,49(6):424-427