| Objective:To observe and analyze the clinical efficacy and application value of tamoxifen(TAM),granulocyte colony stimulating factor(G-CSF)and tamoxifen combined with G-CSF in the frozen-thawed embryo transfer(FET)cycles for patients with thin endometrium.Methods:A total of 149 patients with thin endometrium who received FET in the Department of Reproductive Medicine of the Second Affiliated Hospital of Kunming Medical University from December 2019 to December 2020.These patients had endometrial thickness(EMT)<7mm at least 2 times in the previous natural cycle or hormone replacement cycle.Further randomly divided into 3 groups.Group A:53 patients received tamoxifen therapy;Group B:49 patients received intrauterine G-CSF perfusion therapy;Group C:47 patients received tamoxifen combined with intrauterine G-CSF perfusion therapy.The advantages and disadvantages of the three groups were compared through the self-comparison and the difference of curative effect between the three groups.To compare the EMT differences between the treatment cycle and previous cycles among the three groups.EMT,the pattern of endometrium,endometrial blood flow types,resistance index(RI),pulse index(PI),systolic/diastolic blood pressure(S/D)between the three groups were compared.Differences of serum estradiol(E2)levels,endometrial preparation time and pregnancy outcomes of three groups were compared.Relationship between the development of dominant follicles and outcome after tamoxifen treatment.Results:1.Comparison of ultrasonic parameters of the three groups in different periods:the EMT of the three groups on the endometrial transformation day of the treatment cycle increased significantly compared with the treatment cycle D10 and previous cycles(P<0.001).The proportion of type A endometrium in group B and group C on endometrium conversion day was significantly higher than that on D10(P<0.05),but there was no such difference in group A.Compared with D10,the proportion of type II+III blood flow of the three groups on the day of endometrial transformation was significantly higher(P<0.05).Compared with D10,the endometrial and subendometrial blood flow indices RI,PI and S/D of the three groups showed a decreasing trend on the endometrial transformation day(P<0.05).2.Comparison of ultrasonic parameters among the three groups:the increase of the EMT in the group A and C were significantly increased when compared with group B(P<0.05),while there was no statistical significance between group A and group C(P>0.05).There was no significant difference in the proportion of type A endometrium on D10 and the day of endometrial transformation among the three groups(P>0.05).The proportion of type II+III blood flow of the group A and C on D10 was better than that of group B(P<0,05),while there was no statistical significance between group A and group C(P>0.05);There was no significant difference in the proportion of type II+III blood flow on the day of endometrial transformation among the three groups(P>0.05).There were no significant differences in RI,PI and S/D on D10 among the three groups(P>0.05).Compared with group A,RI,PI and S/D in the group B and C were significantly lower(P<0.05),while there was no statistical significance between group B and group C(P>0.05).3.Comparison of outcomes among the three groups:the level of serum E2 in groups A and C on the endometrial transformation day was higher than that in group B(P<0.05),while there was no statistically significant difference between group A and C(P>0.05).The number of days of endometrial preparation in group A and group C was lower than that in group B(P<0.05),while there was no statistically significant difference between group A and C(P>0.05).There were no significant differences in embryo implantation rate,biochemical pregnancy rate,clinical pregnancy power and early abortion rate among the three groups(P>0.05).After tamoxifen treatment,the level of serum E2 in the dominant follicle group on the endometrial transformation day was significantly higher than that in the non-dominant follicle group(P<0.05),but there was no statistical significance in EMT and clinical pregnancy rate(P>0.05).Conclusions:1.Tamoxifen,G-CSF and tamoxifen combined with G-CSF all improved endometrial thickness,endometrial blood flow and related pregnancy outcomes in patients with thin endometrium,among which tamoxifen combined with G-CSF had the most significant effect.2.In terms of pregnancy outcomes after the treatment of tamoxifen,the endometrial thickness and hormone level are more important than the development of dominant follicles... |
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