CAJ | 학술논문

目的探讨17β雌二醇在激素替代内膜准备冻融胚胎移植(FET)中的应用并与戊酸雌二醇进行比较,探讨不同内膜厚度及雌激素(E2)水平对临床结局的影响.方法收集2012年1至6月在浙江大学医学院附属邵逸夫医院生殖中心行激素替代(HRT)内膜准备FET周期1072个,根据使用的药物类型分两组:A组:仅使用戊酸雌二醇准备内膜(798个周期);B组:如仅使用戊酸雌二醇不能达到满意的内膜厚度及E2水平,或反复移植失败,则采用戊酸雌二醇+17β雌二醇准备内膜(274个周期),比较两种内膜准备方案患者的基本情况及临床结局的差异.比较内膜厚度及E2不同分层临床结局的差异,并将B组内膜＜7 mm与2011年相同内膜厚度的患者比较.结果 A组第1次移植比例、内膜准备周期的平均内膜厚度均显著高于B组,并且＜7 mm比例B组8.8％,A组2.4％,差异有统计学意义.但两组总临床妊娠率(54.8％比52.9％)、胚胎种植率(38.1％比35.8％)差异无统计学意义.随内膜增厚,胚胎种植率和临床妊娠率呈上升趋势;不同E2水平间的临床结局差异均无统计学意义;而B组内膜＜7 mm的病例与2011年HRT周期相同内膜厚度(均仅用戊酸雌二醇)比较结果提示,戊酸雌二醇+17β雌二醇方案的临床妊娠率、胚胎种植率及活胎产率均要高于2011年,差异无统计学意义.结论对于子宫内膜薄,单纯使用戊酸雌二醇不能获得满意内膜厚度或理想雌激素水平的患者,在FET的HRT内膜准备中可以加用17β雌二醇阴道吸收,能增加内膜厚度,改善内膜容受性,从而获得较理想的临床结局.
목적 탐토17β자이순재격소체대내막준비동융배태이식(FET)중적응용병여무산자이순진행비교,탐토불동내막후도급자격소(E2)수평대림상결국적영향.방법 수집2012년1지6월재절강대학의학원부속소일부의원생식중심행격소체대(HRT)내막준비FET주기1072개,근거사용적약물류형분량조:A조:부사용무산자이순준비내막(798개주기);B조:여부사용무산자이순불능체도만의적내막후도급E2수평,혹반복이식실패,칙채용무산자이순+17β자이순준비내막(274개주기),비교량충내막준비방안환자적기본정황급림상결국적차이.비교내막후도급E2불동분층림상결국적차이,병장B조내막＜7 mm여2011년상동내막후도적환자비교.결과 A조제1차이식비례、내막준비주기적평균내막후도균현저고우B조,병차＜7 mm비례B조8.8％,A조2.4％,차이유통계학의의.단량조총림상임신솔(54.8％비52.9％)、배태충식솔(38.1％비35.8％)차이무통계학의의.수내막증후,배태충식솔화림상임신솔정상승추세;불동E2수평간적림상결국차이균무통계학의의;이B조내막＜7 mm적병례여2011년HRT주기상동내막후도(균부용무산자이순)비교결과제시,무산자이순+17β자이순방안적림상임신솔、배태충식솔급활태산솔균요고우2011년,차이무통계학의의.결론 대우자궁내막박,단순사용무산자이순불능획득만의내막후도혹이상자격소수평적환자,재FET적HRT내막준비중가이가용17β자이순음도흡수,능증가내막후도,개선내막용수성,종이획득교이상적림상결국.
Objective To explore the application of Femoston in hormone replacement treatmentfrozen embryo transfer (HRT-FET) versus endometrial preparation with Progynova and examine the effects of different endometrial thickness and estradiol levels on clinical outcomes.Methods Retrospective analysis was conducted for a total of 1072 HRT-FET cycles at our center during January-June 2012.According to the type of medication,the patients were divided into 2 groups:Group A:Progynova only (798 cycles).Group B:non-satisfactory endometrial thickness or E2 level only by Progynova or repeated implantation failure,Progynova plus Femoston for preparing endometrium (274 cycles).Then the inter-group differences of basic profiles and clinical outcomes were compared.Comparison of clinical outcomes was performed based on different estradiol (E2) levels and endometrial thickness on the day of using progesterone.And then,the patients whose endometrial double thickness was thinner than 7 mm in Progynova + Femoston group were compared with the group of similar endometrial thickness in 2011.The data were analyzed with SPSS 16.0.Results In Group A,the percentage of first transfer,average endometrial thickness on the day of using progesterone in FET cycles were all significantly higher than Group B.And the ratio of ＜ 7 mm was significantly higher in Group B (8.8％ vs 2.4％).However,no significant differences existed in clinical pregnancy rate (54.8％ vs 52.9％) or embryo implantation rate (38.1％ vs 35.8％).With endometrial thickening,both clinical pregnancy and embryo implantation rates increased.There was no significant difference in maximum E2 level.Clinical pregnancy rate,embryo implantation rate and live birth rate of the patients whose endometrial double thickness was thinner than 7 mm in Group B were all higher than those of similar endometrial thickness (all Progynova only) in 2011.Conclusion For patients with thin endometrium,vaginal Femoston may be added if ideal endometrial thickness or E2 level is not achieved by Progynova alone.It improves endometrial receptivity and clinical outcomes are more satisfactory.