Gonadotropin-releasing hormone agonist,Adenomyosis,Frozen-thawed embryo transfer,Invitro fertilization/intracytoplasmic sperm injection-embryo transfer,Clinical pregnancy rate ,"/> <div> <span style="font-size:14px;line-height:2;">促性腺激素释放激素激动剂预处理时间</span><span style="font-size:14px;">对子宫腺肌病合并不孕症患者妊娠结局</span><span style="font-size:14px;">的影响</span> </div>
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发育医学电子杂志  2022, Vol. 10 Issue (6): 417-422    DOI: 10.3969/j.issn.2095-5340.2022.06.003
  围产医学   论著 |产科 |
促性腺激素释放激素激动剂预处理时间对子宫腺肌病合并不孕症患者妊娠结局的影响
焦婷婷 李建华 张水文 王建业 魏岩
解放军总医院妇产医学部 解放军总医院第七医学中心 生殖医学科,北京 100700
Effect of gonadotropin-releasing hormone agonist pretreatment time on the reproductive outcomes in infertile patients with adenomyosis
Jiao Tingting, Li Jianhua, Zhang Shuiwen, et al
Reproductive Medical Center, the Seventh Medical Center of PLA General Hospital, Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100700, China)
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摘要 
【摘要】 目的  探讨促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist,GnRH-a)预
处理时间对子宫腺肌病合并不孕症患者冻融胚胎移植(frozen-thawed embryo transfer,FET)妊娠结局的影响。 方法 收集 2019 年 1 月至 2020 年 4 月于解放军总医院第七医学中心生殖医学科接受体外受精 / 卵胞质内单精子注射 - 胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo

transfer,IVF/ICSI-ET)治疗的 317 例子宫腺肌病合并不孕症患者 FET 周期的临床病例资料。根据 FET前 GnRH-a 预处理时间分为 1 个月组(n=97)、3 个月组(n=139)和 6 个月组(n=81),比较 3 组患者之间的基本资料、临床和实验室情况以及妊娠结局。统计学方法采用方差分析、χ 2 检验。 结果 3 组患者的年龄、体质量指数(body mass index,BMI)、基础卵泡生成素(follicle-stimulating hormone,FSH)水平、基础窦卵泡数、不孕年限、子宫腺肌病类型比较,差异均无统计学意义(P 值均 >0.05)。3 组患者的促性腺激素(gonadotropin,Gn)天数、Gn 总剂量、获卵数、受精率、卵裂率、优质胚胎数、转化日内膜厚度、移植胚胎数、处理前子宫体积大小比较,差异均无统计学意义(P 值均 >0.05)。预处理 1 个月组的平均子宫体积大于预处理 3 个月组和 6 个月组 [(216±149)、(157±101)、(142±89)cm3 ,t=3.874、4.309,P均 <0.01]。3 组患者的移植胚胎数、胚胎种植率和流产率比较,差异均无统计学意(P 值均 >0.05)。3 组患者的临床妊娠率比较,差异有统计学意义(χ 2 =6.468,P=0.039),其中GnRH-a 预处理 3 个月组的临床妊娠率高于 1 个月组和 6 个月组 [66.9%(93/139)、53.6%(52/97

51.9%(42/81),χ 2 =4.265、4.892,P 值均 <0.05]。3 组患者的活产率比较,差异有统计学意义(χ 2 =6.020,P=0.049),其中 GnRH-a 预处理 3 个月组的活产率高于 1 个月组和 6 个月组[55.4%(77/139)、42.3%(41/97)、40.7%(33/81),χ 2 =3.938、4.397,P 值均 <0.05]。 结论 子宫腺肌病合并不孕症患者 FET 前使用 GnRH-a 预处理可以有效缩小子宫体积,预处理 3 个月可以获得较高的临床妊娠率和活产率。

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关键词:  促性腺激素释放激素激动剂  子宫腺肌病  冻融胚胎移植  体外受精   卵胞质内单精子注射  胚胎移植  临床妊娠率    
Abstract: 
【Abstract】Objective To investigate the impact of gonadotropin-releasing hormone agonist(GnRH-a) pretreatment time on the reproductive outcomes of frozen-thawed embryo transfer (FET) ininfertile patients with adenomyosis. Method The clinical data of 317 patients with adenomyosis andinfertile treated by in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSIET) during FET cycle were collected from January 2019 to April 2020 in the Reproductive MedicalCenter, the Seventh Medical Center of PLA General Hospital. According to the pretreatment time ofGnRH-a before FET transfer, the patients were divided into 1 month group (n=97), 3 months group(n=139) and 6 months group (n=81). The basic data, clinical and laboratory conditions and pregnancyoutcomes were compared among the three groups. Statistical analysis performed by analysis of Varianceand χ 2 test. Result There were no signifificant difference in the age, body mass index (BMI), basal folliclestimulating hormone (FSH) level, basal sinus follicle number, infertility years, and adenomyosis type of thethree groups (all P>0.05). There were no statistically signifificant difference in the number of gonadotropin(Gn) days, total Gn dose, number of eggs obtained, fertilization rate, cleavage rate, number of high-qualityembryos, endometrium thickness on transformation days, number of embryos transferred and uterine volumebefore treatment (all P>0.05). The average uterine volume after treatment in 1 month group was larger thanthat in the 3 months group and 6 months [(216±149), (157±101), (142±89) cm3 , t=3.874, 4.309, P<0.01].There were no significant difference in the number of transferred embryos, embryo implantation rate andmiscarriage rate among the three groups (all P>0.05). The clinical pregnancy rate of the three groups ofpatients was signifificantly different (χ 2 =6.468, P=0.039). Among them, the clinical pregnancy rate of 3 monthsgroup was higher than that in the 1 month group and 6 months group [66.9% (93/139), 53.6% (52/97), 51.9%(42/81), χ 2 =4.265, 4.892, all P<0.05]. There was a statistically significant difference in the live birth rateamong the three groups (χ 2 =6.020, P=0.049), and the live birth rate in the 3 months group was higher thanthat in the 1 month group and 6 months group [55.4% (77/139), 42.3% (41/97), 40.7% (33/81), χ 2 =3.938,4.397, all P<0.05]. Conclusion The use of GnRH-a pretreatment before FET embryo in patients withadenomyosis and infertile can effectively reduce the uterine volume, and the treatment for 3 months hasa higher clinical pregnancy rate and live birth rate
Key words:  Gonadotropin-releasing hormone agonist')" href="#">
收稿日期:  2022-01-27                     发布日期:  2022-11-29     
基金资助: 吴阶平医学基金会临床科研专项资助基金(320.6750.18462)
通讯作者:  魏岩    E-mail:  weiyan7989@sohu.com
引用本文:    
焦婷婷 李建华 张水文 王建业 魏岩.
促性腺激素释放激素激动剂预处理时间对子宫腺肌病合并不孕症患者妊娠结局的影响
[J]. 发育医学电子杂志, 2022, 10(6): 417-422.
Jiao Tingting, Li Jianhua, Zhang Shuiwen, et al. Effect of gonadotropin-releasing hormone agonist pretreatment time on the reproductive outcomes in infertile patients with adenomyosis. Journal of Developmental Medicine(Electronic Version), 2022, 10(6): 417-422.
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