为冻融胚胎移植做准备:临床实践的最新进展。

Preparation of the endometrium for frozen embryo transfer: an update on clinical practices.

机构信息

Center for Reproductive Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.

Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.

出版信息

Reprod Biol Endocrinol. 2023 Jun 8;21(1):52. doi: 10.1186/s12958-023-01106-5.

Abstract

Over the past decade, the application of frozen-thawed embryo transfer treatment cycles has increased substantially. Hormone replacement therapy and the natural cycle are two popular methods for preparing the endometrium. Hormone replacement therapy is now used at the discretion of the doctors because it is easy to coordinate the timing of embryo thawing and transfer with the schedules of the in-vitro fertilization lab, the treating doctors, and the patient. However, current results suggest that establishing a pregnancy in the absence of a corpus luteum as a result of anovulation may pose significant maternal and fetal risks. Therefore, a 'back to nature' approach that advocates an expanded use of natural cycle FET in ovulatory women has been suggested. Currently, there is increasing interest in how the method of endometrial preparation may influence frozen embryo transfer outcomes specifically, especially when it comes to details such as different types of ovulation monitoring and different luteal support in natural cycles, and the ideal exogenous hormone administration route as well as the endocrine monitoring in hormone replacement cycles. In addition to improving implantation rates and ensuring the safety of the fetus, addressing these points will allow for individualized endometrial preparation, also as few cycles as possible would be canceled.

摘要

在过去的十年中,冷冻胚胎移植治疗周期的应用大大增加。激素替代疗法和自然周期是两种常用的子宫内膜准备方法。由于激素替代疗法易于协调胚胎解冻和移植与体外受精实验室、治疗医生和患者的时间表,因此现在由医生自行决定使用。然而,目前的结果表明,由于排卵障碍导致黄体缺失而建立妊娠可能会给母婴带来重大风险。因此,有人提出了一种“回归自然”的方法,即提倡在排卵的女性中扩大使用自然周期 FET。目前,人们越来越关注子宫内膜准备方法如何影响冷冻胚胎移植的结果,特别是在排卵监测的不同类型、自然周期中的不同黄体支持以及激素替代周期中外源激素给药途径和内分泌监测等细节方面。除了提高着床率和确保胎儿安全外,解决这些问题还可以实现个体化的子宫内膜准备,并且尽可能减少取消周期的数量。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2045/10249325/2009b753934c/12958_2023_1106_Fig1_HTML.jpg

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