目的 探讨高龄患者不同内膜准备方案对冻融胚胎移植妊娠结局的影响。 方法 回顾性分析2022年4月至2025年4月于河南省生殖妇产医院接受体外受精（IVF）或卵胞浆内单精子注射技术（ICSI）助孕后行冻融胚胎移植的504例高龄患者（年龄35 ~ 45岁），根据移植策略分为自然周期（NC）组（n = 102）、激素替代周期（HRT）组（n = 268）和降调节-激素替代（GnRH-a + HRT）组（n = 134）。比较3组患者的临床妊娠率、持续妊娠率、流产率、生化妊娠率，并分析影响临床妊娠因素的风险因素。 结果 （1）3组患者间的年龄、抗苗勒管激素（AMH）、体质量指数（BMI）、不孕年限、受精方式、移植胚胎类别差异均无统计学意义（P > 0.05），GnRH-a + HRT组移植日内膜厚度高于NC组和HRT组，差异有统计学意义（P < 0.05）。（2）GnRH-a + HRT组的临床妊娠率、持续临床妊娠率均高于NC组及HRT组，差异有统计学意义（P < 0.05），3组间流产率、生化妊娠率差异无统计学意义（P > 0.05）。（3）多因素logistic回归分析结果显示，年龄升高是临床妊娠的危险因素（OR = 0.896，P < 0.05），内膜厚度增加、高AMH水平是临床妊娠的保护因素（OR = 1.171、1.089，P < 0.05），移植类型、移植方案是高龄患者临床妊娠的独立危险因素。 结论 对于高龄患者，采用GnRH-a + HRT方案可以改善子宫内膜容受性，提高临床妊娠率，改善妊娠结局。GnRH-a + HRT可作为高龄患者有效的FET内膜准备方案。

Objective To explore the influence of different endometrial preparation regimens for elderly patients on the pregnancy outcomes of frozen-thawed embryo transfer. Methods A retrospective analysis was performed on 504 elderly patients （aged 35 ~ 45 years） who underwent frozen-thawed embryo transfer after receiving IVF or ICSI-assisted pregnancy at Henan Provincial Reproductive and Obstetrics Hospital from April 2022 to April 2025. These patients were divided into the natural cycle （NC） group （n = 102）， hormone replacement cycle （HRT） group （n = 268）， and down-regulation-hormone replacement （GnRH-a + HRT） group （n = 134） according to the transfer strategy. The clinical pregnancy rate， continuous pregnancy rate， miscarriage rate， and biochemical pregnancy rate of the three patient groups were compared， and the risk factors influencing clinical pregnancy were analyzed. Results （1） There were no statistically significant differences among the three groups of patients regarding age， anti-Mullerian hormone （AMH）， body mass index （BMI）， duration of infertility， fertilization method， and type of transplanted embryo （P > 0.05）. The endometrial thickness on the transplantation day in the GnRH-a + HRT group was greater than that in the NC group and the HRT group， and this difference was statistically significant （P < 0.05）. （2） Both the clinical pregnancy rate and the sustained clinical pregnancy rate in the GnRH-a + HRT group were higher than those in the NC group and the HRT group， and the differences were statistically significant （P < 0.05）. There were no statistically significant differences in the miscarriage rate and biochemical pregnancy rate among the three groups （P > 0.05）. （3） The results of multivariate Logistic regression analyses indicated that increased age was a risk factor for clinical pregnancy （OR = 0.896， P < 0.05）， whereas increased endometrial thickness and high AMH level were protective factors for clinical pregnancy （OR = 1.171， 1.089， respectively， P < 0.05）. Transplantation type and transplantation protocol are independent risk factors for clinical pregnancy in elderly patients. Conclusions For elderly patients， the GnRH-a + HRT regimen is capable of enhancing endometrial receptivity， elevating the clinical pregnancy rate， and improving pregnancy outcomes. Therefore， GnRH-a + HRT can serve as an effective endometrial preparation protocol for frozen-embryo transfer （FET） in elderly patients.