Page 17 - 中国全科医学2022-03

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Influence of Two Endometrial Preparation Programs Independent of Endogenous Ovarian Cycle on the Pregnancy
Outcome of Thin Endometrial Patients with Freeze-thaw Embryo Transfer WEI Longlong，ZHANG Cuilian *
Reproductive Medicine Center of Henan Provincal People's Hospital，Zhengzhou 450052，China
*
Corresponding author：ZHANG Cuilian，Chief physician，Professor，Doctoral supervisor；E-mail：1257672564@qq.com
【Abstract】 Background Thin endometrium is one of the crucial reasons leading to the reduction of pregnancy
rate in patients. The whole embryo freezing is an important strategy in the process of assisting pregnancy in patients with thin
endometrium. However，there are still controversies regarding the choice of subsequent freeze-thaw embryo transfer. Objective
To explore the difference between two endometrial preparation programs〔artificial cycle and gonadotropin releasing hormone
agonist（GnRH-a） down regulating artificial cycle〕 independent of endogenous ovarian cycle in patients with thin endometrial.
Methods A retrospective analysis of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET）
assisted pregnancy treatment was performed in the Reproductive Center of Henan Provincial People's Hospital from December
2016 to July 2019. The whole embryo was frozen due to endometrial thickness less than 7 mm in the month of egg collection，
then the clinical data of the freezing-thawing embryo transfer patients were collected by artificial cycle （artificial cycle group，
n=409） and GnRH-a down-regulated artificial cycle （GnRH-a down-regulated artificial cycle group，n=103）. Pregnancy
results were compared between the two groups of patients. Results The average number of transplanted embryos in the artificial
cycle group was （1.60±0.49），while that in the GnRH-a daon-regulated artificial cycle group was（1.66±0.52），and
there was no statistically significant difference between the two groups（P>0.05）. In the artificial cycle group，there were
no significant differences in clinical pregnancy rate，implantation rate，abortion rate，ectopic pregnancy rate and multiple
pregnancy rate among those with 1，2 and 3 embryos transferred，respectively（P>0.05）. In the GnRH-a down-regulated
artificial cycle group，there were also no significant differences in clinical pregnancy rate，implantation rate，abortion rate，
ectopic pregnancy rate and multiple fetus rate among those with 1，2 and 3 embryos transferred，respectively（P>0.05）.
Conclusion In patients with thin endometrium thickness（≤ 7 mm），two endometrial preparation programs （artificial cycle
and GnRH-a） independent of endogenous ovarian cycle had similar results in regulating artificial cycle pregnancy. It is not
recommended to use GnRH-a combined with hormone replacement in the endometrial preparation program of conventional thin
endometrial patients without special medical history such as endometriosis and repeated implant failure.
【Key words】 Uterine diseases；Thin endometrium；Embryo transfer；Number of embryos transferred；Pregnancy
rate；Menstrual cycle

在采用辅助生殖技术进行助孕的过程中，薄型子宫
本研究价值：
内膜是临床医师面临的非常棘手的问题。在所有进行体
如何改善薄型子宫内膜患者的助孕结局是当前辅
外受精 - 胚胎移植的患者群体中，薄型子宫内膜患者约 助生殖技术的研究难点及热点。然而，在薄型子宫内
占 2.4% ［1］ 。结合现有研究，多数专家划定子宫内膜厚 膜群体中使用何种内膜准备方案可以提高其冻融移植
度 <7 mm 作为薄型子宫内膜的阈值 ［1］ 。薄型子宫内膜
周期的妊娠率尚存极大争议。本研究发现，在无子宫
对女性生育的影响非常显著，目前国内外观察一致显示，
内膜异位症、腺肌症、多囊卵巢综合征及反复种植失
无论是在新鲜周期还是复融移植周期中，薄型子宫内膜 败病史等特殊病史的薄型子宫内膜患者群体中常规使
患者的妊娠率较正常人群显著降低 ［2-3］ 。然而令人极为
用促性腺激素释放激素激动剂（GnRH-a）联合激素
困扰的是，目前关于薄型子宫内膜尚无行之有效的治疗
替代的内膜准备方案无明显益处，反而增加其经济及
办法。有研究指出，若在黄体前期给予注射促性腺激素
心理负担。
释放激素激动剂（GnRH-a），患者的胚胎种植率和妊
娠率均可获得提高 ［4］ 。但该观点仍存争议，尚需要大 1 对象与方法
规模临床研究加以证实。本研究旨在通过对进行冻融胚 1.1 研究对象 回顾性分析 2016 年 12 月至 2019 年 7
胎移植的子宫内膜厚度≤ 7 mm 患者的临床资料进行回 月于河南省人民医院生殖中心接受体外受精 / 卵胞质内
顾性分析，探讨使用 GnRH-a 进行降调节相较非降调节 单精子显微注射胚胎移植（IVF/ICSI-ET）助孕治疗，
人工周期是否可以改善薄型子宫内膜患者的妊娠结局， 取卵当月因子宫内膜厚度≤ 7 mm 进行全胚冷冻，后采
以期探索在冻融周期中对薄型子宫内膜患者有效而经济 用人工周期和 GnRH-a 降调节人工周期进行冻融胚胎移
的内膜准备方案。 植患者的临床资料。纳入标准：（1）转化日子宫内膜