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宫腔灌注HCG对反复种植失败患者妊娠结局的影响
作者:季晓媛  苏雁  李欣  季慧  凌秀凤  赵纯  张军强  王培 
单位:南京医科大学附属妇产医院/南京市妇幼保健院 生殖医学中心, 江苏 南京 210004
关键词:人绒毛膜促性腺激素 宫腔灌注 冻融胚胎移植 反复种植失败 妊娠结局 
分类号:R321.33
出版年·卷·期(页码):2021·40·第一期(7-11)
摘要:

目的:探讨反复种植失败(RIF)患者在冻融胚胎移植(FET)前行人绒毛膜促性腺激素(HCG)宫腔灌注对妊娠结局的影响。方法:回顾性分析2017年1月至2018年6月于南京医科大学附属妇产医院生殖医学中心行FET的218例RIF患者的病历资料,根据移植前是否行HCG宫腔灌注分为观察组(80例)和对照组(138例)。比较两组临床妊娠率、早期流产率、胚胎种植率、异位妊娠率、多胎妊娠率及活产率等临床指标,并进一步比较移植不同类型胚胎(卵裂期胚胎或囊胚)时是否行HCG宫腔灌注的临床结局差异。结果:观察组临床妊娠率(53.750%)、胚胎种植率(31.677%)、活产率(41.250%)均高于对照组(34.783%、21.456%、23.913%),差异均有统计学意义(P<0.05)。行囊胚移植的RIF患者中HCG灌注组临床妊娠率(60.000%)和胚胎种植率(44.068%)均优于对照组(37.500%和25.000%),差异均有统计学意义(P<0.05);而早期流产率(14.286%vs 29.630%)、异位妊娠率(0 vs 3.704%)、多胎妊娠率(23.810%vs 11.111%)及活产率(42.857%vs 25.000%)差异均无统计学意义(P>0.05)。结论:对于拟行FET的RIF患者,移植前行HCG宫腔灌注有利于胚胎着床,提高临床妊娠率,对改善RIF患者妊娠结局有一定积极意义;并且在囊胚移植时宫腔灌注HCG较卵裂期胚胎移植时灌注可能具有更明显的优势。

Objective: To investigate the effect of human chorionic gonadotropin(HCG) intrauterine perfusion on pregnancy outcome in patients undergoing repeated implantation failure(RIF) during freeze-thawed embryo transfer (FET). Methods: Retrospective analysis was based on the data of 218 FET cycles with RIF patients from our institution from January 2017 to June 2018. According to the presence or absence of intrauterine perfusion before transplantation, 80 cases were assigned into observation group(group G1) and 138 cases control group(group G2). Patients' general situations, cycle conditions and pregnancy outcomes were compared between these two groups. A further comparison of the clinical outcome of HCG intrauterine perfusion of different types of embryos(cleavage stage embryo or blastocyst) was made. Results: In group G1,the clinical pregnancy rate(53.750%), embryo implantation rate(31.677%) and live birth rate(41.250%) were all higher than those in the group G2 respectively(34.783%, 21.456%, 23.913%), the differences were statistically significant(P<0.05). In RIF patients who underwent blastocyst transfer, their clinical pregnancy rate(60.00% vs 37.5%) and embryo implantation rate(44.068% vs 25.000%) were superior to the control group, with a statistical difference(P<0.05), however, early abortion rate(14.286% vs 29.630%), ectopic pregnancy rate(0 vs 3.704%), multiple pregnancy rate(23.810% vs 11.111%) and live birth rate(42.857% vs 25.000%) were not statistically significant(P>0.05). Conclusion: For patients with RIF who are planning FET, HCG intrauterine perfusion before transplantation is beneficial to embryo implantation and clinical pregnancy rate, which has certain positive significance for improving the pregnancy outcome of RIF patients. This research also shows that HCG intrauterine perfusion may be more suitable for patients undergoing blastocyst transfer than cleavage stage embryo transfer.

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