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山东大学学报 (医学版) ›› 2023, Vol. 61 ›› Issue (10): 63-68.doi: 10.6040/j.issn.1671-7554.0.2023.0500

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GnRH-a预处理对子宫内膜异位症患者替代方案冻胚移植结局的影响

张丽霞1,2,3,田一正1,吕尚格1,张亚男1,2,颜磊1,2   

  1. 1.山东大学生殖医学研究中心, 山东 济南 250021;2.山东大学附属生殖医院妇科, 山东 济南 250021;3.阳谷县妇幼保健计划生育服务中心, 山东 阳谷 252300
  • 发布日期:2023-11-08
  • 通讯作者: 张亚男. E-mail:1192185709@qq.com颜磊. E-mail: yanlei@sdu.edu.cn
  • 基金资助:
    国家重点研发计划(2022YFC2704002);国家自然科学基金(82071617)

Effects of GnRH-a pretreatment on the pregnancy outcomes of frozen embryo transplantation in patients with endometriosis

ZHANG Lixia1,2,3, TIAN Yizheng1, LYU Shangge1, ZHANG Yanan1,2, YAN Lei1,2   

  1. 1.Center for Reproductive Medicine, Cheeloo College of Medicine Shandong University, Jinan 250021, Shandong, China;
    2. Department of Gynecology, Reproductive Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China;
    3. Maternal and Child Health and Family Planning Service Center of Yanggu County, Liaocheng 252300, Shandong, China
  • Published:2023-11-08

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摘要： 目的 探讨促性腺激素释放激素激动剂(GnRH-a)预处理对行激素替代方案(HRT)冻胚移植的子宫内膜异位症患者妊娠结局的影响。 方法 回顾性分析2016年1月至2019年12月在山东大学附属生殖医院接收冷冻胚胎移植(FET)的子宫内膜异位症患者643例,按照子宫内膜准备方案分为:实验组(GnRH-a+HRT组,261个冻胚移植周期)与对照组(HRT组,382个冻胚移植周期)。比较2种内膜准备方案的FET妊娠结局。主要结局指标包括活产率、流产率。采用二元 Logistic回归分析矫正影响妊娠结局的混杂因素。 结果 两组患者基础黄体生成素(LH)、基础雌激素(E2)、基础泌乳素(PRL)、基础促甲状腺激素(TSH)、促性腺激素(Gn)天数、不孕类型等一般临床资料均无统计学差异(P>0.05)。而GnRH-a+HRT组的年龄、基础卵泡刺激素(FSH)、Gn总量及人绒毛膜促性腺激素(HCG)日内膜厚度高于HRT组,抗苗勒管激素(AMH)、窦卵泡数(AFC)、体质量指数(BMI)、基础雄激素(T0)低于HRT组,差异有统计学意义(P<0.05)。调整各种混杂因素后显示,GnRH-a+HRT组患者流产率下降(OR=0.607,95%CI=0.378~0.973,P=0.038),但活产率差异无统计学意义。高龄(OR=0.931,95%CI=0.891~0.973,P=0.002)、高FSH水平(OR=0.924,95%CI=0.855~0.998,P=0.043)与较低的活产率相关。 结论 对行FET的子宫内膜异位症患者行替代方案前进行GnRH-a预处理,能够降低流产率,但尚未能显著提高活产率,仍需大样本研究进一步证实。

关键词: 子宫内膜异位症, 促性腺激素释放激素激动剂, 替代方案, 冻融胚胎移植, 妊娠结局

Abstract: Objective To investigate the effects of pretreatment of gonadotrophin releasing hormone agonist(GnRH-a)for hormone replacement treatment(HRT)on the pregnancy outcomes in patients with endometriosis(EMs)after frozen embryo transplantation(FET). Methods Clinical data of 643 EMs patients who received FET in the Affiliated Reproductive Hospital of Shandong University during Jan. 2016 and Dec. 2019 were retrospectively analyzed. According to the endometrial preparation regimen, the patients were divided into experimental group(GnRH-a+HRT group, 261 frozen embryo transfer cycles)and control group(HRT group, 382 frozen embryo transfer cycles). The pregnancy outcomes were compared between the two groups, including live birth rate and abortion rate. Binary Logistic regression was used to correct confounding factors affecting pregnancy outcomes. Results There were no significant differences in the number of days of basic luteinizing hormone(LH), basic estrogen(E2), basic prolectin(PRL), basic thyrotropin(TSH), gonadotropin(Gn)and infertility types between the two groups(P>0.05). The age, basic follicle stimulating hormone(FSH), total amount of Gn and daily intimal thickness of human chorionic gonadotropin(HCG)were higher in the GnRH-a+HRT group, while anti-Mullerian hormone(AMH), antral follicle count(AFC), body mass index(BMI)and basic androgen(T0)were lower in the HRT group(P<0.05). After adjusting for confounders, the GnRH-a+HRT group was associated with a lower risk of miscarriage(OR=0.607, 95%CI=0.378-0.973, P=0.038)but not with live birth rate. Old age(OR=0.931, 95%CI=0.891-0.973, P=0.002)and high FSH level(OR=0.924, 95%CI=0.855-0.998, P=0.043)were negatively associated with live birth rate. Conclusion GnRH-a pretreatment for endometriosis patients undergoing FET before HRT can reduce the risk of abortion, but cannot significantly improve the live birth rate. Further study is needed to confirm the conclusion.

Key words: Endometriosis, Gonadotropin-releasing hormone agonist, Hormone replacement treatment, Freeze-thaw embryo transfer, Pregnancy outcomes

中图分类号: 

  • R711.71
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