Reproductive Medicine Center, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Department of Gynecology and Gynecological Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Medicine (Baltimore). 2022 Aug 5;101(31):e29928. doi: 10.1097/MD.0000000000029928.
The well-prepared endometrium with appropriate thickness plays a critical role in successful embryo implantation. The thin endometrium is the main factor of frozen-embryo transfer (FET), resulting in the failure of implantation undergoing FET. Hormone treatment is suggested to improve endometrium thickness; however, among the larger numbers of cases, it cannot reach the sufficient thickness, which leads to a high cancelation rate of embryo transfer as well as waste high-quality embryos. Thus, it increases the burden to patients in both economic and psychological perspectives. We performed a retrospective observational study, which was composed with 2 cohorts, either with the conventional hormone replacement therapy (HRT) protocol or HRT with gonadotrophin-releasing hormone agonist (GnRHa) pretreatment to prepare the endometrium before FET. The measurements of endometrium thickness, hormone level, transfer cycle cancelation rate, pregnancy rate, and implantation rate were retrieved from the medical records during the routine clinic visits until 1 month after embryo transfer. The comparisons between 2 cohorts were performed by t-test or Mann-Whitney U test depending on the different attributions of data. In total, 49 cycles were under HRT with GnRHa pretreatment and 84 cycles were under the conventional HRT protocol. HRT with GnRHa pretreatment group improved the endometrial thickness (8.13 ± 1.79 vs 7.51 ± 1.45, P = .031), decreased the transfer cancelation rate (P = .003), and increased clinical pregnancy rate and implantation rate significantly (both P = .001). Additionally, luteinizing hormone level in pretreatment group was consistently lower than conventional HRT group (P < .05). Our study revealed HRT with GnRHa pretreatment efficiently improved the endometrial thickness, therefore, decreased the FET cycle cancelation. It also elevated the embryo implantation rate and clinical pregnancy rate by improving endometrial receptivity.
准备良好、厚度适当的子宫内膜对于胚胎着床的成功起着至关重要的作用。薄型子宫内膜是冷冻胚胎移植（FET）失败的主要原因，导致FET 着床失败。激素治疗被建议用于改善子宫内膜厚度；然而，在更多的病例中，它无法达到足够的厚度，这导致胚胎移植的取消率很高，同时浪费了高质量的胚胎。因此，这在经济和心理方面都增加了患者的负担。我们进行了一项回顾性观察研究，该研究由两个队列组成，一个是采用常规激素替代治疗（HRT）方案，另一个是在 FET 前采用 HRT 加促性腺激素释放激素激动剂（GnRHa）预处理来准备子宫内膜。从常规临床就诊的病历中检索了子宫内膜厚度、激素水平、移植周期取消率、妊娠率和着床率等测量值，直到胚胎移植后 1 个月。根据数据的不同属性，通过 t 检验或 Mann-Whitney U 检验对两个队列进行了比较。共有 49 个周期采用 GnRHa 预处理 HRT，84 个周期采用常规 HRT 方案。GnRHa 预处理 HRT 组改善了子宫内膜厚度（8.13±1.79 比 7.51±1.45，P=0.031），降低了移植取消率（P=0.003），并且显著提高了临床妊娠率和着床率（均 P=0.001）。此外，预处理组的黄体生成素水平始终低于常规 HRT 组（P<0.05）。我们的研究表明，GnRHa 预处理 HRT 可有效改善子宫内膜厚度，从而降低 FET 周期取消率。它还通过提高子宫内膜容受性来提高胚胎着床率和临床妊娠率。
