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目的:探讨冻胚移植失败PCOS患者再次冻胚移植内膜准备的最佳方案。方法:回顾分析2011年8月~2013年7月在青岛市妇女儿童医院生殖中心行人工周期准备内膜冻融胚胎移植的PCOS患者的临床资料,对移植失败或因突破性出血取消周期尚有冻存胚胎的162例PCOS患者实施再次冻胚移植。将患者随机分为GnRHa+人工周期(降调节+人工周期组)、人工周期和诱导排卵方案3组,观察3组患者的年龄、体重指数(BMI)、不孕年限、胚胎冻存时间、突破性出血率、周期取消率、优质胚胎率、移植胚胎数、移植日子宫内膜厚度及类型、内膜增殖时间、内膜转化日血清雌激素浓度、种植率、妊娠率、流产率、异位妊娠率。结果:降调节+人工周期组和诱导排卵组无一例发生突破性出血。诱导排卵组内膜转化日E2平均水平为(2827.33±1148.49)pg/ml,高于其他2组,差异有统计学意义(P<0.05);平均子宫内膜厚度为(9.14±0.90)mm,较其他2组增高,但差异无统计学意义(P>0.05)。诱导排卵组的B级以下内膜所占比例最低,为9.76%,但差异无统计学意义(P>0.05)。降调节+人工周期组的临床妊娠率和着床率分别为50.94%和22.54%,诱导排卵组分别为53.66%和22.77%,与人工周期组(31.03%,13.07%)比较,差异均有统计学意义(P<0.05)。结论:对于PCOS患者,初次冻胚移植失败后再次冻胚移植时采用降调节+人工周期方案或诱导排卵方案,可降低突破性出血率,减少周期取消,提高妊娠率和着床率。
OBJECTIVE: To explore the optimal solution of frozen embryo transfer endomembrane in PCOS patients with failed frozen embryo transfer. Methods: The clinical data of PCOS patients who underwent endometrial freeze-thaw embryo transfer in the Reproductive Center of Women and Children’s Hospital of Qingdao City from August 2011 to July 2013 were retrospectively analyzed. There was still no evidence of graft failure or cancellation due to breakthrough bleeding 162 frozen PCOS embryos in patients with frozen embryo transplantation. The patients were randomly divided into three groups: GnRHa + artificial cycle (down regulation + artificial cycle), artificial cycle and ovulation induction. The age, body mass index (BMI), duration of infertility, embryo cryogenic time, Hemorrhage rate, cycle cancellation rate, high quality embryo rate, number of embryos transferred, endometrial thickness and type on transplantation day, proliferative time of endometrium, serum estrogen concentration on endometrial transformation day, implantation rate, pregnancy rate, miscarriage rate, ectopic pregnancy rate. Results: There was no case of breakthrough bleeding in the down regulation + artificial cycle group and ovulation induction group. The average level of endometrial E2 in induced ovulation group was (2827.33 ± 1148.49) pg / ml, which was higher than the other two groups (P <0.05). The mean endometrial thickness was (9.14 ± 0.90) mm, Compared with the other two groups increased, but the difference was not statistically significant (P> 0.05). The percentage of intima below grade B in induced ovulation group was the lowest (9.76%), but the difference was not statistically significant (P> 0.05). The clinical pregnancy rate and implantation rate in the hypothyroidism + artificial cycle group were 50.94% and 22.54%, respectively, and ovulation induction group was 53.66% and 22.77%, respectively, which were statistically different from those in the artificial cycle group (31.03%, 13.07%) Significance (P <0.05). CONCLUSIONS: In patients with PCOS, the reduction of the rate of breakthrough bleeding, the reduction of cycles, and the improvement of pregnancy rate and implantation rate can be achieved by using the regimen of lowering regulation + artificial cycle or the induction of ovulation when the frozen embryo transplantation fails again after the initial cold frozen embryo transplantation.