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目的探讨子宫内膜准备方案及体质量指数(BMI)对多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)妊娠结局的影响。方法回顾性分析2018年1月至2020年9月在我院生殖中心行FET助孕PCOS患者的临床资料(共550个周期)。根据不同内膜准备方案分为3组:人工周期组(A组,366个周期),降调节+人工周期组(B组,116个周期),促排卵周期组(C组,68个周期),比较各组患者的年龄、不孕年限、BMI、优质胚胎率、复苏胚胎数、移植胚胎数、胚胎复苏率、转化日子宫内膜厚度、临床妊娠率、胚胎着床率、早期流产率和继续妊娠率等指标;又根据不同BMI分组,比较不同BMI组间妊娠结局的差异。结果不同内膜准备方案各组患者的一般资料比较,转化日子宫内膜厚度B组显著高于A组和C组(P<0.05),临床妊娠率(65.51%vs. 53.01%)、继续妊娠率(57.76%vs. 44.81%)和胚胎着床率(48.84%vs. 39.09%)B组均显著高于A组,早期流产率B组显著低于A组(7.89%vs. 12.37%)(P均<0.05),其余指标各组间均无显著性差异(P>0.05)。不同BMI亚组间,超重组的临床妊娠率(50.00%vs. 59.66%)、继续妊娠率(41.49%vs. 53.22%)和胚胎着床率(36.36%vs. 44.38%)均显著低于正常组,早期流产率肥胖组(17.50%)和超重组(14.89%)均显著高于正常组(7.38%)(P<0.05)。结论采用GnRH-a降调节后联合人工周期方案可以有效提高继续妊娠率、降低早期流产率,而BMI的升高则会降低胚胎着床率和继续妊娠率,同时使不良妊娠的风险增加。因此,对于PCOS患者,控制BMI到正常范围以及采用降调节+人工周期方案进行内膜准备可能更有利于改善FET周期的妊娠结局。
Abstract：Objective:To investigate the influence of endometrial preparation protocol and body mass index(BMI) on the pregnancy outcomes of frozen-thawed embryo transfer(FET) in the patients with polycystic ovary syndrome(PCOS).Methods:The clinical data of the infertile patients with PCOS(550 cycles) who underwent FET assisted pregnancy in Center for Reproductive Medicine of our hospital from January 2018 to September 2020 were retrospective analyzed. The patients were divided to three groups according to endometrial preparation protocol: the hormone replacement group(group A,n=366),the pituitary down-regulation combined with hormone replacement group(group B,n=116) and the ovulation induction group(group C,n=68). The age, duration of infertility, BMI,high-quality embryos rate, number of embryos transferred, number of embryos thawed, embryo survival rate after thawed, the endometrial thickness on the conversion day, clinical pregnancy rate, embryo implantation rate, early abortion rate and continuous pregnancy rate were compared among the groups. Then patients were grouped according to BMI to compare the pregnancy outcomes of each subgroup.Results:The data analysis of each group suggested that the endometrial thickness on the conversion day of group B was significantly higher than that of group A and group C(P<0.05). The clinical pregnancy rate(65.51% vs. 53.01%),ongoing pregnancy rate(57.76% vs. 44.81%) and embryo implantation rate(48.84% vs. 39.09%) in group B were significantly higher than those in group A(P<0.05). The early abortion rate in group B was significantly lower than that in group A(7.89% vs. 12.37%,P<0.05). There were no significant differences in other indexes among the groups(P>0.05). After grouping according to BMI,the clinical pregnancy rate(50.00% vs. 59.66%),ongoing pregnancy rate(41.49% vs. 53.22%) and embryo implantation rate(36.36% vs. 44.38%) in over weight group were significantly lower than those in normal weight group(P<0.05). The early abortion rate in obesity group(17.50%) and overweight group(14.89%) was significantly higher than that of normal group(7.38%)(P<0.05).Conclusions:GnRH-a combined with hormone replacement can effectively increase the ongoing pregnancy rate and reduce the early abortion rate. Meanwhile, increase of BMI is associated with decrease of implantation rate and ongoing pregnancy rate, and increase of adverse pregnancy risk. Therefore, using GnRH-a combined with hormone replacement for endometrial preparation and controlling BMI to the normal range may be more conducive to improve the pregnancy outcome of FET for patients with PCOS.
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基本信息:
中图分类号:R714.8
引用信息:
[1]付贝贝,漆倩荣,谢青贞.内膜准备方案及BMI对多囊卵巢综合征患者冻融胚胎移植结局的影响[J].生殖医学杂志,2021,30(11):1427-1432.
基金信息:
国家自然科学基金项目(81471456)
2021-11-15
2021-11-15