Effects of Different FET Schemes on Endometrial Thickness，Endometrial Blood Flow and Pregnancy Outcome in Patients with Endometrial Tuberculosis
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摘要:
目的 对比分析自然周期（natural cycle，NC）、激素替代周期（hormone replacement treatment cycle，HRT）与促性腺激素释放激素激动剂-激素替代周期（gonadotropin releasing hormone agonist-hormone replacement treatment cycle，GnRH-a-HRT）3种不同冻融胚胎移植（frozen-thawed embryo transfer，FET）方案对子宫内膜结核患者内膜转化日子宫内膜厚度、内膜血流及FET妊娠结局的影响。 方法 收集2017年01月01日至2021年01月01日在昆明医科大学第二附属医院生殖医学科行FET助孕的子宫内膜结核患者，根据患者FET内膜准备方案分为NC组、HRT组及GnRH-a-HRT组。比较3组患者子宫内膜厚度、内膜血流及胚胎移植结局。 结果 对3组患者的妊娠结局进行比较分析后发现，GnRH-a-HRT组患者胚胎种植率、临床妊娠率、继续妊娠率及活产率均高于HRT组与NC组患者，差异均具有统计学意义（P < 0.05）；HRT组患者胚胎种植率、临床妊娠率、继续妊娠率及活产率均高于NC组患者，差异均具有统计学意义（P < 0.05）。对3组患者子宫内膜厚度及内膜血流进行比较分析后发现，GnRH-a-HRT组患者子宫内膜厚度、内膜血流PSV值均高于HRT组与NC组患者，而内膜血流RI值与PI值均低于HRT组与NC组，差异具有统计学意义（P < 0.05）；HRT组患者子宫内膜厚度及内膜血流PSV值高于NC组，而内膜血流RI值与PI值均低于NC组，差异具有统计学意义（P < 0.05）。 结论 子宫内膜 结核患者采用GnRH-a-HRT进行内膜准备后，可改善提高患者内膜转化日内膜厚度及内膜血流PSV值，降低内膜血流RI及PI值，并最终改善子宫内膜结核FET妊娠结局。 Abstract:Objective To compare and analyze the effects of three different frozen-thawed embryo transfer（FET） protocols natural cycle（NC）, hormone replacement cycle（HRT） and gonadotropin releasing hormone agonist-hormone replacement cycle（GnRH-a-HRT） on endometrial thickness on the day of endometrial transformation, endometrial blood flow and the pregnancy outcome of FET in patients with endometrial tuberculosis. Methods Patients with endometrial tuberculosis who underwent FET in the Reproductive Medicine Department of the Second Affiliated Hospital of Kunming Medical University from January 1st, 2017 to January 1st, 2021 were collected. According to the FET endometrial preparation protocol, the patients were divided into NC group, HRT group and GnRH-a-HRT group respectively. After the comparation and analysis to the endometrial thickness, endometrial blood flow and embryo transfer outcomes were compared among the three groups; Results The embryo implantation rate, clinical pregnancy rate, continuing pregnancy rate and live birth rate in GnRH-a HRT group were higher than those in HRT group（P < 0.05）. The embryo implantation rate, clinical pregnancy rate, ongoing pregnancy rate and live birth rate in HRT group were higher than those in NC group, and the differences were statistically（P < 0.05）. The endometrial thickness and endometrial blood flow of the three groups, it was found that the endometrial thickness and PSV value of the endometrial blood flow in the GnRH-a HRT group were higher than those in the HRT group and NC group, while the RI value and PI value of the endometrial blood flow were lower than those in the HRT group and NC group（P < 0.05）. The endometrial thickness and PSV of the HRT group were higher than those of the NC group, while the RI and PI of the endometrial blood flow were lower than those of the NC group, and the differences were statistically（P < 0.05）; Conclusion GnRH-a-HRT can improve the endometrial thickness and PSV value of endometrial blood flow on the day of endometrial transformation, reduce the RI and PI value of endometrial blood flow, and finally improve the pregnancy outcome of FET for patients with endometrial tuberculosis. -
Key words:
- FET scheme /
- Endometrial tuberculosis /
- Intimal thickness /
- Intimal blood flow /
- Pregnancy outcome /
- Influence
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表 1 3组患者一般情况比较（
$\bar{x} \pm s $ ）Table 1. Comparison of general conditions among the three groups（
$\bar{x} \pm s $ ）组别 n 年龄
（岁）不孕年
限（a）BMI
（kg/m2）基础FSH
（mIU/mL）基础LH
（mIU/mL）基础E2
（pg/mL）基础P
（ng/mL）基础PRL
（ ng/mL）基础T
（ ng/dL）AMH
（ng/mL）TSH
（mIU/L）NC组 31 30.35 ± 4.33 3.77 ± 2.01 22.01 ± 1.95 4.89 ± 1.09 5.05 ± 0.95 45.34 ± 10.22 0.39 ± 0.17 18.89 ± 3.24 20.21 ± 1.86 1.79 ± 0.45 2.17 ± 0.75 HRT组 29 29.93 ± 3.42 4.34 ± 1.76 21.69 ± 1.38 5.20 ± 0.81 5.02 ± 0.83 46.49 ± 11.25 0.42 ± 0.19 17.44 ± 3.97 19.64 ± 2.55 1.91 ± 0.48 2.06 ± 0.64 GnRH-a-
HRT29 30.69 ± 4.51 4.10 ± 1.84 21.90 ± 1.30 5.27 ± 0.76 5.27 ± 0.68 48.04 ± 9.16 0.46 ± 0.21 18.58 ± 3.04 19.46 ± 1.94 1.89 ± 0.60 1.86 ± 0.55 F / 0.25 0.70 0.32 1.54 0.78 0.52 1.06 1.45 1.02 0.49 1.79 P / 0.78 0.50 0.73 0.22 0.46 0.59 0.35 0.24 0.37 0.61 0.17 
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表 2 3组患者子宫内膜厚度及内膜血流比较（
$\bar{x} \pm s $ ）Table 2. Comparison of endometrial thickness and endometrial blood flow among the 3 groups（
$\bar{x} \pm s $ ）组别 n 子宫内膜厚度（mm） RI PI PSV NC组 31 7.00 ± 1.13* 0.55 ± 0.04* 1.97 ± 0.11* 16.33 ± 0.79* HRT组 29 7.86 ± 0.95# 0.51 ± 0.04# 1.87 ± 0.09# 16.76 ± 0.62# GnRH-a-HRT组 29 8.45 ± 1.15∆ 0.48 ± 0.04∆ 1.70 ± 0.06∆ 17.32 ± 0.75∆ F 13.65 18.10 72.92 13.93 P < 0.001☆ < 0.001☆ < 0.001☆ < 0.001☆ 与HRT组比较，*P < 0.05；与GnRH-a-HRT组比较，#P < 0.05；NC组组比较；∆P < 0.05；☆P < 0.05。
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表 3 3组患者移植后结局比较 （n）
Table 3. Comparison of outcomes after transplantation among the three groups （n）
组别 n 胚胎种植率 临床妊娠率 生化妊娠率 早期流产率 继续妊娠率 活产率 NC组 31 （6/31）* （6/31）* （2/31） （1/4） （3/31）* （3/31）* HRT组 29 （13/29）# （13/29）# （2/29） （1/10） （9/29）# （9/29）# GnRH-a-HRT组 29 （21/29）∆ （21/29）∆ （1/29） （2/20） （18/29）∆ （17/29）∆ X2 17.24 17. 24 0.39 0.77 18.54 16.39 P < 0.001☆ < 0.001☆ 0.824 0.682 < 0.001☆ < 0.001☆ 与HRT组比较，*P < 0.05；与GnRH-a-HRT组比较，#P < 0.05；与NC组比较，∆P < 0.05；☆P < 0.05。
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