| Objective:Compare the effect of different kind,dose and dosing mode of estrogen in the membrane preparation in freezing thawing embryo transfer using hormone replace treatment,looking for a better therapy to improve the clinical pregnancy rate.Methods:Respectively reviewed cases in hormone replacement therapy in frozen embryo transfer from July 2014 to June 2018 of Shandong University Qilu Hospital Reproductive Medical Center.Inclusive criteria:?females between 20-43 years old,?females with normal uterine cavity form,?had not using hormone in recent 3 months.Exclusion criteria:? uterine malformation including separate uterus,bicornate uterus,infantile uterus,uterus dysgenesis and so on,?with diseases which influence uterine form,like uterine fibroid,adenomyosis and so on,?with diseases which influence uterine cavity form,like endometrial polyp intrauterine adhesion and so on.A total of 1290 cycles were performed,including 789 cases of blastocyst transplantation and 501 cases of cleavage stage embryo transplantation.The 789 cases of blastocyst transplantation included 67 cases of oral estradiol valerate group,618 cases of oral 17?-estradiolum group,71 cases of increased dose and duration of oral estrogen group,8 cases of oral estradiol valerate + vaginal using 17?-estradiolum group,and 25 cases of oral 17?-estradiolum + vaginal using 17?-estradiolum group.The 501 cases of cleavage stage embryo transplantation included 72 cases in the oral estradiol valerate group,351 cases in the oral 17?-estradiolum group,51 cases in the increased dose and duration of oral estrogen group,9 cases in the oral estradiol valerate + vaginal using 17?-estradiolum group,and 18 cases in the oral 17?-estradiolum + vaginal using 17?-estradiolum group.To study the role of different types of oral estrogen in endometrial preparation effect,we separated patients into blastocyst group and cleavage stage embryo group.Compared the age,body mass index(BMI),the average number of embryo transfer,endometrial thickness on the day of embryo transfer,biochemical pregnancy rate and clinical pregnancy rate between the patients using oral estradiol valerate and those using oral 17?-estradiolum in each group.In our center,for patients with endometrial thickness<8mm detected by B-mode ultrasound on the 10th day of treatment,the oral estrogen dose was increased and the duration of estrogen medication was prolonged.To study the effect of prolonged dosing time and increase dosage in the endometrial preparation,we separated patients into blastocyst group and cleavage stage embryo group.Compared the age,body mass index(BMI),the average number of embryo transfer,endometrial thickness on the day of embryo transfer,the time and dosage of using estrogen before adding progestogen,biochemical pregnancy rate and clinical pregnancy rate between the patients using increased dose and duration of oral estrogen and those using normal dose and duration of oral estrogen in each groupFor patients whose cycle was cancelled due to the thin endometrium(<6mm)after increasing estrogen dose and duration,the next cycle was to prepare the endometrium by oral estrogen + vaginal 17?-estradiolum.To study the effects of different dosing mode in the endometrial preparation,we compared the age,body mass index(BMI),the average number of embryo transfer,the percentage of blastocyst transplantation,the time of using estrogen before adding progestogen,endometrial thickness on the day of embryo transfer,the percentage of patients whose endometrial thickness>8mm on the day of embryo transfer,endometrium growth after adding extra estrogen,biochemical pregnancy rate and clinical pregnancy rate.Data analysis was performed using SPSS 22.0 statistical software.All values are presented as the means ± SD.Normally distributed data were compared using variance(ANOVA)tests and independent t-tests.Abnormally distributed or Unequal Variances data were compared using Nonparametric tests.Comparison of rates were using Continuity Correction and Fisher's Exact test.In searching for variables associated with the outcome,we considered as statistically significant a P value below 0.05.Results:There were no significant differences between the oral 17?-estradiolum group and the oral estradiol valerate group in age,body mass index,embryo number,endometrial thickness on the day of transplantation,biochemical pregnancy rate,and clinical pregnancy rate(P>0.05).The duration and total dose of estrogen before adding progestogen were higher in the increased dose and duration of oral estrogen group than in the normal dose and duration of oral estrogen group,and the endometrial thickness was thinner on the transplantation day,showing a significant difference(P<0.05).There were no significant differences between the two groups in terms of age,body mass index,number of transplanted embryos,biochemical pregnancy rate and clinical pregnancy rate(P>0.05).Compared to the oral Estradiol valerate or 17?-estradiolum + virginal using 17?-estradiolum group,increased dose and duration of oral estrogen group was younger,transplanted less number of embryos,the time of using estrogen before adding progestogen was shorter,the percentage of patients with endometrial thickness?8mm was higher,showing a significant difference(P<0.05).There were no significant differences between the two groups in age,body mass index,the number of transplanted embryos,the percentage of blastocyst transplantation,thickness of endometrium on the day of transplantation,endometrium growth after adding extra estrogen,biochemical pregnancy rate and clinical pregnancy rate(P>0.05).among the patients whose endomembrane still could not reach 8mm after the increase of oral estrogen dose and time,51.7%of the patients who received oral + vaginal estrogen therapy in this cycle had endometrial thickness ?8mm,and the pregnancy rate of this part of patients was significantly increased compared to those whose endomembrane was thinner than 6mm.Conclusions:1.In endometrial preparation of hormone replacement treatment in frozen embryo transfer,there is no significant difference between oral estradiol valerate and oral 17?-estradiolum in terms of endometrial thickness on the transplantation day and clinical pregnancy rate.2.In endometrial preparation of hormone replacement treatment,increasing estrogen duration and total dose can improve clinical pregnancy rate in patients with Endometrial dysplasia.3.For patients with endometrial dysplasia,in the endometrial preparation of hormone replacement therapy,vaginal use of 17?-estradiolum has advantages over oral estrogen in improving endometrial thickness and clinical pregnancy rate. |
PDF Full Text Request