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目的:探讨降调节联合人工周期方案对冻融胚胎移植助孕周期临床妊娠结局的影响。方法:收集到行冻融胚胎移植助孕治疗的297个周期,按不同内膜准备方案分组,133例降调节联合人工周期为降调节组,164例行单纯人工周期为人工周期组进行比较分析,同时对部分2种方案均实施过的同一患者进行自身对照分析,并对影响降调节联合人工周期的妊娠结局进行多因素回归分析。结果:患者的年龄、不孕年限、基础FSH、体质量指数(BMI)、内膜厚度、移植胚胎数、优质胚胎数、优质胚胎率、多胎率、异位妊娠率、早期流产率组间均无统计学差异(P>0.05)。降调节组的临床妊娠率、胚胎着床率分别为42.11%(56/133)、24.32%(81/333),显著高于人工周期组的29.88%(49/164)、13.83%(52/376),差异有统计学意义(P<0.05)。自身对照分析显示患者的内膜厚度、优质胚胎率均无统计学差异(P>0.05),但降调节联合人工周期的临床妊娠率[52.17%(24/46)]显著高于单纯人工周期的[13.04%(6/46)],差异有统计学意义(P<0.05)。另外,Logistic回归分析显示,优质胚胎数、手术史可影响妊娠结局。结论:在临床上,对于既往有盆腔手术史、多次冻融周期助孕失败史的患者,可试行降调节联合人工周期方案进行助孕。
OBJECTIVE: To investigate the effect of combination of hypothyroidism and artificial cycle on clinical pregnancy outcomes during pregnancy and embryo transfer in frozen-thawed embryos. Methods: A total of 297 cycles of assisted pregnancy with frozen-thawed embryo transfer were collected, divided into groups according to different endometrial preparation plans, 133 cases with down regulation combined with artificial cycle as down regulation group, 164 cases with simple artificial cycle as artificial cycle group , While some of the two programs were implemented in the same patient self-control analysis, and the impact of down regulation combined with artificial cycle pregnancy outcome by multivariate regression analysis. Results: The age of patients, age of infertility, basal FSH, body mass index (BMI), thickness of intima, numbers of embryos transferred, number of high quality embryos, quality embryos, multiple births, ectopic pregnancies and early miscarriage rates No statistical difference (P> 0.05). The clinical pregnancy rate and embryo implantation rate were 42.11% (56/133) and 24.32% (81/333) in the hypothyroidism group, which were significantly higher than those in the artificial cycle group (29.88%, 13/83, 52.8% 376), the difference was statistically significant (P <0.05). The self-control analysis showed that there was no significant difference in the thickness of the intima and the rate of high-quality embryos (P> 0.05), but the clinical pregnancy rate (52.17%, 24/46) was significantly higher than that of the artificial cycle [13.04% (6/46)], the difference was statistically significant (P <0.05). In addition, Logistic regression analysis showed that the number of high-quality embryos, surgical history can affect pregnancy outcomes. Conclusion: Clinically, patients with previous history of pelvic surgery and multiple failed cycles of pregnancy-induced convalescence may be given trial-assisted co-treatment with the combination of hypothyroidism and artificial cycle.