生殖医学杂志

目的 通过Meta分析探究不同内膜准备方案对子宫内膜异位症(EMs)合并不孕患者的冻融胚胎移植(FET)妊娠结局的影响。方法 检索包括中国知网(CNKI)、中国维普数据库、中国生物医学文献数据库(CBM)、万方数据库、EMBASE、Web of Science、PubMed以及Cochrane Library在内的多个数据库进行了文献搜索，并辅以手工检索。纳入截至2024年6月1日发表的关于不同内膜准备方案对EMs合并不孕的患者行FET的临床妊娠结局影响的研究，由两名研究者合作评价纳入文献的质量，然后再利用RevMan 5.4软件进行Meta分析。结果 共纳入9篇文献。Meta分析结果表明，在EMs合并不孕患者的FET周期中，选用促性腺激素释放激素激动剂(GnRH-a)降调节后人工周期(GnRH-a+HRT)方案准备内膜的临床妊娠率、胚胎着床率及移植日子宫内膜厚度显著高于人工周期(HRT)方案和自然周期(NC)方案(P<0.05)。与NC方案相比，应用HRT方案的患者流产率显著降低(P<0.05),但临床妊娠率、胚胎着床率及子宫内膜厚度未见显著差异(P>0.05)。关于异位妊娠率、多胎妊娠率、活产率以及胚胎移植数等其他结局指标，不同内膜准备方案之间未显示出显著差异(P>0.05)。结论 与其他两种方案相比，GnRH-a+HRT方案提高了临床妊娠率、胚胎着床率及子宫内膜厚度，显著改善了EMs合并不孕患者的FET妊娠结局；相较于NC方案，HRT方案则降低了FET周期的流产率。需要注意的是，本研究结论主要基于中国人群的研究结果，仍需在其他人群中进一步验证以提高外推性。

Objective:To assess the impact of endometrial preparation protocols on pregnancy outcomes of frozen-thawed embryo transfer(FET) cycles in infertile patients with endometriosis(EMs) by using a meta-analysis.Methods:Online searches were conducted in China National Knowledge Infrastructure(CNKI),VIP Database, Chinese Biomedical Literature Database(CBM),Wanfang Database, EMBASE,Web of Science, PubMed, and the Cochrane Library, supplemented by manual searches. Clinical studies published up to June 1,2024 were included to assess the impact of various endometrial preparation protocols on pregnancy outcomes following FET in infertile patients with endometriosis. The quality of the included studies was jointly assessed by two researchers, and RevMan 5.4 software was used for the meta-analysis.Results:A total of 9 studies were included. The meta-analysis results showed that in FET for infertile patients with endometriosis, the clinical pregnancy rate, embryo implantation rate and endometrial thickness on the day of embryo transfer were significantly higher with the protocol using GnRH agonist(GnRH-a) downregulation followed by hormone replacement therapy [GnRH-a+ hormone replacement therapy(HRT)] compared to the HRT protocol and the natural cycle(NC) protocol(P<0.05). Compared to the NC protocol, the miscarriage rate in patients using the HRT protocol was significantly lower(P<0.05),while clinical pregnancy rate, embryo implantation rate and endometrial thickness did not show significant differences(P>0.05). No statistically significant differences were found in ectopic pregnancy rate, multiple pregnancy rate, live birth rate and the number of embryos transferred among the various endometrial preparation protocols(P>0.05).Conclusions:Compared to the other two protocols, the GnRH-a+HRT protocol improves clinical pregnancy rate, embryo implantation rate and endometrial thickness, significantly promoting pregnancy outcomes in infertile patients with endometriosis undergoing FET. Compared to the NC protocol, the HRT protocol reduces the miscarriage rate in FET cycle. It is important to note that the findings of this study are primarily based on research conducted in Chinese population, and further validation in other populations is needed to enhance the generalizability of the results.