经皮雌二醇凝胶在血栓前状态患者冻融胚胎移植中的应用OACSTPCD

Objective:To investigate the value of transdermal estradiol gel in hormone replacement treatment(HRT)for endometrial preparation in frozen-thawed embryo transfer(FET)cycles among the patients with prothrombotic state. Methods:Sixty-eight patients with prothrombotic state who underwent HRT-FET at the Reproductive Hospital of the Second Affiliated Hospital of Zhengzhou University from February 2021 to February 2023 were recruited.Patients who underwent endometrial preparation with percutaneous estradiol gel were assigned in the study group(n=32),and those who underwent endometrial preparation with oral Femoston in the control group(n=36).Low molecular heparin was given after embryo transfer in both groups.HRT profile and FET pregnancy outcome were compared between the two groups,together with fibrinogen(FIB),prothrombin time(PT),activated partial thromboplastin time(APTT),prothrombin time(TT)and D-dimer(D-D)levels before and 14 days after embryo transfer in the same group and 14 days after embryo transfer between the groups. Results:The endometrial thickness on the day of progesterone conversion and the proportion of type A endometrium were significantly higher in the study group than those in the control group(P＜0.05).There were no significant differences in the number of embryos transferred,the rate of transferring favorable embryos,and positive rate of human chorionic gonadotropin(HCG)between the two groups(P＞0.05).The clinical pregnancy rate of the study group was significantly higher than that of the control group(65.63％vs.41.67％,P＜0.05),and the rate of early miscarriage in the study group tended to decrease when compared with that of the control group,but showing no significant difference(9.38％vs.16.67％,P＞0.05).Fourteen days after embryo transfer,the levels of FIB and D-D were significantly lower than those before embryo transfer in either group(P＜0.01).The levels of D-D and FIB in the study group are significantly lower than those in the control group 14 days after embryo transfer(P＜0.01). Conclusions:In HRT-FET cycle among patients with prothrombotic state,the use of transdermal estradiol gel could reduce the risk of prothrombotic state and increase endometrial tolerance,resulting in improved outcomes of assisted reproduction compared with oral Femoston.Therefore it is recommended to choose transdermal estradiol for endometrial preparation and supplement with heparin for symptomatic management among patients with prothrombotic state.