冻融胚胎移植前日雌二醇水平与扳机日单卵泡雌二醇水平差异对妊娠结局的影响OA
Effect of the difference between estradiol level on the day before frozen-thawed embryo transfer and single follicular estradiol level on trigger day on pregnancy outcomes
目的 分析冻融胚胎移植(FET)前日雌二醇(E2)与取卵周期中扳机日单卵泡E2水平差异与 FET结局的关联.方法 回顾性分析2018年10月至2023年12月于我院生殖医学科行FET的1 100个周期患者的临床资料,根据FET前日E2与取卵周期扳机日单卵泡E2水平差异(即E2比值)分为3组:E2下降组(A组,E2比值＜0.7,n=423);E2持平组(B组,E2比值范围为0.7～1.3,n=318);E2升高组(C组,E2比值＞1.3,n=359),比较各组患者的一般情况、促排卵情况及FET结局.结果 各组间年龄、窦卵泡计数、抗苗勒管激素水平等一般资料比较均无统计学差异(P＞0.05).A组FET前日E2水平显著低于B组和C组,而扳机日单卵泡E2、FET前日内膜厚度均显著高于B组和C组(P＜0.05).A组临床妊娠率(50.59％)、活产率(42.08％)均显著低于B组(分别为62.58％、52.52％)和C组(分别为59.05％、49.86％)(P＜0.05).3组间自然流产率比较无统计学差异(P＞0.05).为了控制干扰因素,选择研究对象中FET前日E2水平范围在367～1 835 pmol/L、内膜厚度在9～14 mm的患者进行进一步分析,结果显示,A组活产率最低且显著低于B组(41.24％vs.54.63％,P＜0.05).FET活产影响因素的Logistic回归分析显示:患者年龄[OR=0.965,95％CI(0.932,0.998)]、移植优质胚胎数[OR=1.625,95％CI(1.251,2.111)]、移植胚胎类型[(OR=1.958,95％CI(1.501,2.555)]、E2 比值[OR=1.079,95％CI(1.018,1.143)]是 FET活产的显著影响因素(P＜0.05).结论 FET前日E2与扳机日单卵泡E2水平差异可能与 FET结局有关.当FET前日E2较扳机日单卵泡E2水平下降＞30％时(即E2比值＜0.7),FET周期的活产率降低.
Objectives:To analyze the effect of difference between estradiol(E2)level on the day before frozen-thawed embryo transfer(FET)and single follicular E2 level on trigger day during controlled ovulatory cycle on pregnancy outcomes. Methods:The clinical data of 1 100 patients(1 100 cycles)who underwent FET at the Reproductive Medicine Department of The Affiliated Hospital of Southwest Medical University from October 2018 to December 2023 were analyzed retrospectively.The patients were divided into three groups based on the ratio of the E2 level before FET to single follicular E2 level on trigger day(E2 ratio):＜0.7 for group A with E2 decreased(n=423),0.7 to 1.3 for group B with E2 balanced(n=318),and＞1.3 for group C with E2 increased(n=359).The results of three groups,such as the basic characteristics,ovulation induction and pregnancy outcomes were compared among the three groups. Results:There were no significant differences in age,antral follicle count,anti-Müllerian hormone level among the three groups(P＞0.05).The E2 level on the day before FET in group A was significantly lower than those in groups B and C,and the single follicular E2 level on trigger day and the endometrial thickness were significantly higher than those of groups B and C(P＜0.05).The clinical pregnancy rate(50.59％)and the live birth rate(42.08％)in group A were significantly lower than those in groups B(62.58％,52.52％,respectively)and C(59.05％,49.86％,respectively,P＜0.05).There were no significant differences in the abortion rate among three groups(P＞0.05).In order to control for interference factors,patients with an E2 range of 367-1 835 pmol/L and endometrial thickness of 9-14 mm on the day before FET were selected for the secondary analysis.The results showed that the live birth rate ingroup A(41.24％)was significantly lower than group B(54.63％,P＜0.05).Logistic regression analysis results of the influence on FET live birth rate showed that the patient age[OR=0.965,95％CI(0.932,0.998)],number of high-quality embryos transplanted[OR=1.625,95％CI(1.251,2.111)],the embryo type transferred[(OR=1.958,95％CI(1.501,2.555)],and the ratio of E2 level on the day before FET to single follicular E2 level on trigger day[OR=1.079,95％CI(1.018,1.143)]were significantly correlated with the live birth rate during FET(P＜0.05). Conclusions:The difference between E2 level on the day before FET and single follicular E2 level on trigger day is related to the outcomes of FET.When the E2 level on the day before FET decreases more than 30％compared to the single follicular estradiol level on trigger day(E2 ratio＜0.7),it may cause a significant decrease in the live birth rate of the FET cycle.
徐苗怡;方雲遥;刘尧芳
西南医科大学附属医院生殖医学科,泸州 646000西南医科大学附属医院生殖医学科,泸州 646000西南医科大学附属医院生殖医学科,泸州 646000
医药卫生
雌二醇卵泡冻融胚胎移植妊娠结局
EstradiolFollicleFrozen-thawed embryo transferPregnancy outcome
《生殖医学杂志》 2026 (1)
7-14,8
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