Li Lifei, Kou Zhijian, Fu Yujie, Liang Lanlan, Liu Lin, Zhang Xuehong
Reproductive Medicine Center of the First Hospital of Lanzhou University, Lanzhou, China.
Key Laboratory for Reproductive Medicine and Embryo of Gansu, Lanzhou, China.
Ann Transl Med. 2022 Feb;10(3):131. doi: 10.21037/atm-22-161.
Recurrent implantation failure (RIF) is a critical problem for assisted reproduction technology. High-quality embryos and the synchronization endometrium both have great significance. How to get the optimal endometrial receptivity is a challenge for implantation and pregnancy of infertile patients with RIF. The objective of this study is to investigate personalized protocol of frozen-thawed embryo transfer (FET) cycles, and its effect on clinical outcomes in patients with RIF.
We chose 91 RIF patients from January 2017 to June 2019 in the Reproductive Medicine Center of the First Hospital of Lanzhou University. A total of 100 FET cycles were undertaken with a gonadotropin-releasing hormone agonist (GnRH-agonist) protocol combined with hormone replacement therapy (HRT) for endometrial preparation. The patients were divided into two groups: the routine group (cleavage embryo transferred at day 3 after luteal support) included 48 cycles; the personalized group included 52 cycles with delayed endometrial trigger and luteal support (the time of embryo transfer depended on the level of serum hormone and endometrial thickness).
The data showed the personalized group had longer time for endometrial preparation. On the day of embryo transfer, serum progesterone (P) and the E/P ratio was significantly different compared with the routine group (P<0.05). The clinical pregnancy rate in the routine group was 35.42% (17/48) and 59.62% (31/52) in the personalized group (P<0.05). The abortion rate was not significantly different.
For women with RIF, personalized timing for transfer of FET resulted in a higher clinical pregnancy rate compared with routine protocol.
反复种植失败(RIF)是辅助生殖技术中的一个关键问题。优质胚胎和同步化的子宫内膜都具有重要意义。如何获得最佳的子宫内膜容受性是RIF不孕患者着床和妊娠面临的一项挑战。本研究的目的是探讨冻融胚胎移植(FET)周期的个性化方案及其对RIF患者临床结局的影响。
我们选取了2017年1月至2019年6月在兰州大学第一医院生殖医学中心的91例RIF患者。共进行了100个FET周期,采用促性腺激素释放激素激动剂(GnRH激动剂)方案联合激素替代疗法(HRT)进行子宫内膜准备。患者分为两组:常规组(黄体支持后第3天移植卵裂期胚胎)包括48个周期;个性化组包括52个周期,采用延迟子宫内膜扳机和黄体支持(胚胎移植时间取决于血清激素水平和子宫内膜厚度)。
数据显示个性化组的子宫内膜准备时间更长。在胚胎移植日,血清孕酮(P)和E/P比值与常规组相比有显著差异(P<0.05)。常规组的临床妊娠率为35.42%(17/48),个性化组为59.62%(31/52)(P<0.05)。流产率无显著差异。
对于RIF女性,FET的个性化移植时机与常规方案相比可提高临床妊娠率。