【摘要】 目的探讨降调节激素替代周期中不同雌激素启动时机对既往移植失败患者冻融胚胎移植（FET）临床结局的影响。方法回顾性分析2018年1月至2019年12月于本中心采用降调节激素替代周期准备内膜后行FET的既往移植失败患者的临床资料（共316个周期）。根据促性腺激素释放激素激动剂（GnRH-a）降调节后雌激素启动时机分为两组:A组为GnRH-a降调节后14～29 d添加外源性雌激素,共157个周期;B组为GnRH-a降调节后30～40 d添加外源性雌激素,共159个周期。比较两组患者的一般情况、降调节后的实验室指标及临床妊娠结局。结果两组患者的年龄、体质量指数（BMI）、不孕年限及基础性激素（FSH、LH、E₂）水平等一般情况均无显著性差异（P>0.05）。与A组比较,B组的外源性雌激素用量显著减少[（85.27±33.77）mg vs.（95.20±39.59）mg)],胚胎种植率（33.44%vs. 25.96%）、临床妊娠率（51.57%vs. 40.13%）、活产率（44.65%vs. 33.76%）显著升高（P<0.05）。结论 GnRH-a降调节后30～40 d启动雌激素治疗,能减少外源性雌激素的使用量,提高既往移植失败患者FET的胚胎种植率、临床妊娠率及活产率,改善临床妊娠结局。更多还原

【Abstract】 Objective:To investigate the effect of estrogen initiation timing on clinical outcome of frozen-thawed embryo transfer（FET） cycles with hormone replacement after down-regulation in patients with previous transplantation failure.Methods:The clinical data of 316 cycles with previously failed transplantation which underwent endometrial preparation by using GnRH-a down-regulated hormone replacement cycles were analyzed. According to the timing of estrogen initiation after GnRH-a down-regulation, the cycles were divided into two groups: the exogenous estrogen was added at 14-29 days after down-regulation in group A（157 cycles） and the exogenous estrogen was added at 30-40 days after down-regulation in group B（159 cycles）. The general situation, clinical indicators after down-regulation and clinical outcomes were compared between the two groups.Results:There were no significantly differences in age, body mass index（BMI）,infertility years, basic sex hormones（FSH,LH,E₂） between the two groups（P>0.05）. The amount of exogenous estrogen used in group B was significantly less than that in group A[（85.27±33.77） mg vs.（95.20±39.59）mg, P<0.05]. The embryo implantation rate（33.44% vs. 25.96%）,clinical pregnancy rate（51.57% vs. 40.13%） and live birth rate（44.65% vs. 33.76%） of group B were significantly higher than those of group A（P<0.05）.Conclusions:The estrogen therapy initiated 30-40 days after the GnRH-a down-regulation can decrease the amount of exogenous estrogen used, increase the embryo implantation rate, clinical pregnancy rate and live birth rate, and improve the clinical outcomes in FET cycles of patients with previous transplantation failure.更多还原