Clinical Research On The Effect Of Combined Stimulating Endometrium Hyperplasia On Repeated Implantation Failure Patients After Down Reglulation In Frozen Embryo Cycles

Objective: To observe the treatment effect and use of multiple stimulation endometrium combine with recombinant human granulocyte colony stimulating factor（rhG-CSF）on repeated implantation failure patients in down reglulation frozen-thawed embryo cycles.Methods:129 repeated implantation failure patients（more than 3 times）who would undergo the FET treatment from The fourth hospital of Hebei University from July 2015 to October 2016 were selected.Patients were divided into four group:（1）control group（n=25）（2）single down reglulation group（n=28）: to give down reglulation,not to stimulate the endometrium;（3）single stimulation group（n=34）: not to give down regulation,to stimulate the endometrium;（4）down reglulation+ stimulation endometrium group（n=42）: to give down regulation and stimulate the endometrium.Follow up general information and clinical pregnancy rate,embryo implantation rate,abortion rate and other information of the four groups.Results:1 General comparison: There were no statistical significancein age,body mass index（BMI）,bFSH,b LH,infertility,infertility type,endometrial thickness,number of transplanted embryos and number of implantation failures in the four groups（P>0.05）.2 Overall pregnancy outcome comparison: 129 repeated implantation failure patients with a total of 65 cases of pregnancy,the total clinical pregnancy rate was 50.4%;transfer 228 embryos,implante 83 embryos,the total embryo implantation rate was 36.4%;13 patients were abortion,the total abortion rate was 20.0%,the rates of clinical pregnancy,embryo implantation and abortion were statistically different between the four groups,P values were: P_{total pregnancy}= 0.027,P_{total implantation} = 0.021,P_{total abortion} = 0.018.Down reglulation+ stimulation endometrium group with the highest clinical pregnancy rate,the highest embryo implantation rate and the lowest abortion rate（P<0.05）.3 Clinical pregnancy rates were:36.0% in the control group,42.9% in the single down reglulation group,44.1% in the single stimulation group and 69.1% down reglulation+ stimulation endometrium group.Each experimental group compared with the control group:down reglulation+ stimulation endometrium group has significant difference,but there was no significant difference in the other two groups(P_{down regulation} = 0.610,P_stimulus = 0.531,P_{down + stimulus} = 0.008).Among the three experimental groups,down reglulation+ stimulation endometrium group has significant difference between the single down reglulation group（P = 0.029）and the single stimulation group（P = 0.029）.4 Embryo implantation rates were:27.9% in the control group,28.2% in the single down reglulation group,31.8% in the single stimulation group and 50.7% in down reglulation+stimulation endometrium group.Each experimental group compared with the control group:down reglulation+ stimulation endometrium group has significant difference,but there was no significant difference in the other two groups(P_{down regulation}= 0.970,P_stimulation= 0.664,P_{down + stimulus} = 0.016).Among the three experimental groups,down reglulation+ stimulation endometrium group has significant difference between the single down reglulation group（P = 0.016）and the single stimulation group（P = 0.024）.5 Abortion rates were:44.4% in the control group,33.3% in the single down reglulation group,26.7% in the single stimulation group,3.50% in the stimulation group.Each experimental group compared with the control group:down reglulation+ stimulation endometrium group has significant difference,but there was no significant difference in the other two groups(P_{down regulation} = 0.604,P_stimulus= 0.371,P_{down + stimulus}= 0.009).Among the three experimental groups,down reglulation+ stimulation endometrium group has significant difference between the single down reglulation group（P = 0.008）and the single stimulation group（P = 0.021）.Conclusion :1 The pregnancy outcome in down reglulation was superior to non-down regulation with RIF patients in frozen-thawed embryo cycles.2 The combined treatment of uterine perfusion rhG-CSF after multiple stimulation endometrium can significantly improve the pregnancy outcome in RIF patients,increasing clinical pregnancy rate and embryo implantation,reducing the abortion rate.3 The combined stimulate endometrium treatment after down reglulation can significantly improve the pregnancy outcome on repeated implantation failure patients in frozen-thawed embryo cycles,it would be a new method to treat RIF patients.