| PurposeTo explore in vitro fertilization embryo transfer around peri-implantation D-dimer change and anticoagulation effect on pregnancy outcome.MethodsIn May 2016 to May 2017 were retrospectively analyzed in reproductive center hospital of tianjin medical university general hospital take luteal phase long solutions or short-acting oral contraceptives,pretreatment and transplantation of fresh cycle infertility cases clinical data,included in the total of 179 cases.Group: 1)according to whether d-dimer(d5-7)is normal or not after embryo transplantation,it is divided into the high-value group and the normal group.2)the d-dimer high-value group was divided into aspirin,low-molecular-weight heparin combined anticoagulant group and single low-molecular-weight heparin anticoagulant group.According to the grouping of pregnancy or not,or not grouping of abortion,D5-7 is normal or not grouping,anticoagulation ways,different groups are observed D5-7 change and anticoagulation effect on the pregnancy outcome.Results:(1)Comparison between the gestation group and the ungestation group: age(31.17 ±4.01 years old,33.35±3.61 years old),daily progesterone of HCG(0.91± 0.45ng/ml,1.2±0.73ng/ml),number of transplanted embryos(1.88±0.32,1.67± 0.48),estrogen of 7 days after embryo transplantation(318.25±163pg/ml,107.20±70.37pg/ml)、D5-7(1335.59±1022.63ng/ml,1969.93±1077.88ng/ml),there was a statistically significant difference between the two groups(P < 0.05),and there was no statistically significant difference between the other observation indicators(P > 0.05).(2)Comparison between the abortion group and the continuous pregnancy group: age(33±3.81 years old,30.8±3.97 years old),D5-7(2447.29±1191.32ng/ml,1170.02±896.51 ng/ml)in the two groups compared with statistical difference(P < 0.05),the rest of the observation indexes had no statistical difference(P > 0.05).(3)D5-7 and the relationship between pregnancy and its related factors analysis: D5-7 to normal limit of 500 ng/ml group,D-dimer high value and normal group compared,HCG day estrogen(2931.04±1500.06 pg/ml,1866.98±881.97 pg/ml)and HCG day progesterone(1.09 ±0.51 ng/ml,0.81±0.40 ng/ml),egg number(10.45± 4.13,8.16±3.84),pregnancy rate(56.59%,78%)showed significant difference(P < 0.01),abortion rate(21.92%,7.7%),P=0.056.(4)For D-dimer is higher than normal group,according to anticoagulation in a different way,divided into low molecular heparin and aspirin combination of anticoagulant and single low-molecular-weight heparin group,the pregnancy rate(58.93%,54.79%)and abortion rate(15.15%,27.5%),had no statistical difference(P > 0.05).Conclusion:(1)In COH cycle,with the increasing of the number of eggs,the rise of female,progestational hormone in the body,around peri-implantation D-dimer appears obvious rise,rise in D-dimer negative effects on the pregnancy outcome,a drop in the rate of pregnancy and abortion rates rise;Anticoagulant therapy should be initiated when the d-dimer is greater than 500ng/ml in the peri-implantation period.(2)In COH fresh cycle embryo transplantation,the pregnancy rate of aspirin and low molecular heparin anticoagulation therapy in the high value group of d-dimer during periimplantation was still lower than that of the normal value group of d-dimer.Compared with the single low molecular weight heparin anticoagulation group,the combined anticoagulation group showed no significant improvement in pregnancy outcome.It is considered to be related to the lag time and dosage of drugs.(3)In COH fresh embryo transfer cycle,as the growth of the age,fewer embryos were transplanted the number of embryos,elevated levels of progesterone in HCG and 7 days after embryo transfer of estrogen reduce pregnancy rate;The rate of miscarriage increases with age;... |
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