子宫内膜增生症及早期子宫内膜癌保留生育功能后冻胚移植妊娠结局

doi:10.6040/j.issn.1671-7554.0.2023.0032

摘要/Abstract

摘要： 目的探讨子宫内膜复杂性增生/不典型增生/早期子宫内膜癌保留生育力治疗后冻胚移植子宫内膜准备方案对妊娠结局的影响。方法回顾性分析2015年1月至2020年12月于山东大学附属生殖医院门诊经体外受精或卵细胞质内单精子注射行冻胚移植的经保留生育功能治疗后逆转的子宫内膜复杂性增生/不典型增生/早期子宫内膜癌患者的临床资料,纳入了112例患者的179个冻胚移植周期,按冻胚移植子宫内膜准备方案分为4组:自然周期组(n=29)、促排卵周期组(n=38)、直接替代周期组(n=89)、降调+替代周期组(n=23)。比较分析各组的临床特征和妊娠结局,采用二分类Logistic回归分析影响患者活产率的因素。结果在179个周期中,促排卵周期组与自然周期组、直接替代周期组和降调+替代周期组比较,其妊娠周期活产率(34.2%、31.0%、31.5%、30.4%)、活产率(46.7%、31.8%、34.8%、22.2%)、妊娠周期临床妊娠率(52.6%、37.9%、49.4%、43.5%)、妊娠周期生化妊娠率(65.8%、44.8%、64.0%、47.8%)更高,自然周期组妊娠周期流产率低于其他3组(18.2%、35.0%、36.4%、30.0%),但差异均无统计学意义(P>0.05)。妊娠周期活产率多因素分析结果显示,基础促甲状腺激素(TSH)增加(OR=1.461,95%CI=0.002~2.130)会降低妊娠周期活产率,获卵数增加(OR=0.903,95%CI=0.833~0.980)提高妊娠周期活产率,而冻胚移植子宫内膜准备方案等其他混杂因素与妊娠周期活产率差异无统计学意义(P>0.05)。结论冻胚移植子宫内膜准备方案对于子宫内膜病变保留生育功能治疗后患者的活产率、临床妊娠率、生化妊娠率和流产率没有影响。建议临床医生在冻胚移植中选择规范的子宫内膜准备方案,使患者更快获得临床妊娠。

关键词: 子宫内膜复杂性增生, 子宫内膜不典型增生, 子宫内膜癌, 辅助生殖技术, 冻胚移植, 活产率

Abstract: Objective To investigate the effects of endometrial preparation protocol in frozen embryo transfer(FET)on pregnancy outcomes after fertility preserving treatment of complex hyperplasia/atypical hyperplasia/early-stage endometrial cancer(CH/AEH/EEC). Methods Clinical data of 179 FET cycles of 112 patients with CH/AEH/EEC, who underwent in vitro fertilization or intracytoplasmic single sperm injection(IVF/ICSI)during Jan. 2015 and Dec. 2020 were retrospectively analyzed. The patients were divided into four groups according to endometrial preparation protocols: natural cycle(group 1, n=29), stimulated cycle(group 2, n=38), hormone replacement treatment(group 3, n=89), and down-regulation in combination with hormone replacement therapy(group 4, n=23). Clinical characteristics and IVF/ICSI outcomes were assessed. The influencing factors of live birth rate were determined with binary Logistic regression analysis. Results Compared with groups 2, 3 and 4, group 1 had higher live birth rate per transfer cycle(34.2% vs. 31.0% vs. 31.5% vs. 30.4%), higher live birth rate(46.7% vs. 31.8% vs. 34.8% vs. 22.2%), higher clinical pregnancy rate per transfer cycle(52.6% vs. 37.9% vs. 49.4% vs. 43.5%), higher biochemical pregnancy rate per transfer cycle(65.8% vs. 44.8% vs. 64.0% vs. 47.8%), and lower miscarriage rate per transfer cycle(18.2% vs. 35.0% vs. 36.4% vs. 30.0%), but the differences were not statistically significant(P>0.05). Multivariate regression analysis showed that higher TSH level led to lower live birth rate per transfer cycle(OR=1.461, 95%CI=0.002-2.130), and increased number of retrieved oocytes led to higher live birth rate per transfer cycle(OR=0.903, 95%CI=0.833-0.980). The other potential confounders such as endometrium preparation protocol for FET had no significant correlation with the live birth rate per transfer cycle(P>0.05). Conclusion The endometrial preparation with FET shows no difference in terms of live birth rate, clinical pregnancy rate, biochemical pregnancy rate, and abortion rate of patients after fertility preserving treatment of CH/AEH/EEC. The endometrial preparation with FET should be selected individually so that patients have better endometrial transformation and achieve clinical pregnancy faster.

Key words: Complex hyperplasia, Atypical endometrial hyperplasia, Endometrial cancer, Assisted reproduction technology, Frozen-thawed embryo transfer, Live birth rate

中图分类号:

R714

戚丹,张曦,于倩,崔琳琳,颜磊. 子宫内膜增生症及早期子宫内膜癌保留生育功能后冻胚移植妊娠结局[J]. 山东大学学报 (医学版), 2023, 61(4): 56-63.

QI Dan, ZHANG Xi, YU Qian, CUI Linlin, YAN Lei. Pregnancy outcomes of frozen embryo transfer in 112 patients of endometrial hyperplasia and early-stage endometrial cancer after fertility preserving treatment[J]. Journal of Shandong University (Health Sciences), 2023, 61(4): 56-63.

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