摘要
目的分析冻融胚胎移植(FET)前日雌二醇(E_(2))与取卵周期中扳机日单卵泡E_(2)水平差异与FET结局的关联。方法回顾性分析2018年10月至2023年12月于我院生殖医学科行FET的1100个周期患者的临床资料,根据FET前日E_(2)与取卵周期扳机日单卵泡E_(2)水平差异(即E_(2)比值)分为3组:E_(2)下降组(A组,E_(2)比值<0.7,n=423);E_(2)持平组(B组,E_(2)比值范围为0.7~1.3,n=318);E_(2)升高组(C组,E_(2)比值>1.3,n=359),比较各组患者的一般情况、促排卵情况及FET结局。结果各组间年龄、窦卵泡计数、抗苗勒管激素水平等一般资料比较均无统计学差异(P>0.05)。A组FET前日E_(2)水平显著低于B组和C组,而扳机日单卵泡E_(2)、FET前日内膜厚度均显著高于B组和C组(P<0.05)。A组临床妊娠率(50.59%)、活产率(42.08%)均显著低于B组(分别为62.58%、52.52%)和C组(分别为59.05%、49.86%)(P<0.05)。3组间自然流产率比较无统计学差异(P>0.05)。为了控制干扰因素,选择研究对象中FET前日E_(2)水平范围在367~1835 pmol/L、内膜厚度在9~14 mm的患者进行进一步分析,结果显示,A组活产率最低且显著低于B组(41.24%vs.54.63%,P<0.05)。FET活产影响因素的Logistic回归分析显示:患者年龄[OR=0.965,95%CI(0.932,0.998)]、移植优质胚胎数[OR=1.625,95%CI(1.251,2.111)]、移植胚胎类型[(OR=1.958,95%CI(1.501,2.555)]、E_(2)比值[OR=1.079,95%CI(1.018,1.143)]是FET活产的显著影响因素(P<0.05)。结论FET前日E_(2)与扳机日单卵泡E_(2)水平差异可能与FET结局有关。当FET前日E_(2)较扳机日单卵泡E_(2)水平下降>30%时(即E_(2)比值<0.7),FET周期的活产率降低。
Objectives:To analyze the effect of difference between estradiol(E_(2))level on the day before frozen-thawed embryo transfer(FET)and single follicular E_(2)level on trigger day during controlled ovulatory cycle on pregnancy outcomes.Methods:The clinical data of 1100 patients(1100 cycles)who underwent FET at the Reproductive Medicine Department of The Affiliated Hospital of Southwest Medical University from October 2018 to December 2023 were analyzed retrospectively.The patients were divided into three groups based on the ratio of the E_(2)level before FET to single follicular E_(2)level on trigger day(E_(2)ratio):<0.7 for group A with E_(2)decreased(n=423),0.7 to 1.3 for group B with E_(2)balanced(n=318),and>1.3 for group C with E_(2)increased(n=359).The results of three groups,such as the basic characteristics,ovulation induction and pregnancy outcomes were compared among the three groups.Results:There were no significant differences in age,antral follicle count,anti-Müllerian hormone level among the three groups(P>0.05).The E_(2)level on the day before FET in group A was significantly lower than those in groups B and C,and the single follicular E_(2)level on trigger day and the endometrial thickness were significantly higher than those of groups B and C(P<0.05).The clinical pregnancy rate(50.59%)and the live birth rate(42.08%)in group A were significantly lower than those in groups B(62.58%,52.52%,respectively)and C(59.05%,49.86%,respectively,P<0.05).There were no significant differences in the abortion rate among three groups(P>0.05).In order to control for interference factors,patients with an E_(2)range of 367-1835 pmol/L and endometrial thickness of 9-14 mm on the day before FET were selected for the secondary analysis.The results showed that the live birth rate in group A(41.24%)was significantly lower than group B(54.63%,P<0.05).Logistic regression analysis results of the influence on FET live birth rate showed that the patient age[OR=0.965,95%CI(0.932,0.998)],number of high-quality embryos transplanted[OR=1.625,95%CI(1.251,2.111)],the embryo type transferred[(OR=1.958,95%CI(1.501,2.555)],and the ratio of E_(2)level on the day before FET to single follicular E_(2)level on trigger day[OR=1.079,95%CI(1.018,1.143)]were significantly correlated with the live birth rate during FET(P<0.05).Conclusions:The difference between E_(2)level on the day before FET and single follicular E_(2)level on trigger day is related to the outcomes of FET.When the E_(2)level on the day before FET decreases more than 30%compared to the single follicular estradiol level on trigger day(E_(2)ratio<0.7),it may cause a significant decrease in the live birth rate of the FET cycle.
作者
徐苗怡
方雲遥
刘尧芳
XU Miao-yi;FANG Yun-yao;LIU Yao-fang(Department of Reproductive Medicine,The Affiliated Hospital of Southwest Medical University,Luzhou 646000)
出处
《生殖医学杂志》
2026年第1期7-14,共8页
Journal of Reproductive Medicine
关键词
雌二醇
卵泡
冻融胚胎移植
妊娠结局
Estradiol
Follicle
Frozen-thawed embryo transfer
Pregnancy outcome
