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Abstract：
BACKGROUND: The gonadotropin hormone-releasing hormone agonists (GnRH-a) have been widely used for controlled ovarian stimulation in assisted reproductive technology (ART). The early-follicular long-acting GnRH-a long protocol (EFL) and the luteal phase short-acting GnRH-a long protocol (LPS) are commonly used GnRH agonist protocols. We conducted a retrospective analysis to assess and compare the rates of congenital abnormalities and safety profiles in offspring born from the EFL and LPS protocols.
METHODS: We conducted a retrospective cohort study to analyze and compare neonatal data from patients who using EFL or LPS protocols at our center between January 1, 2014, and June 30, 2017. The study ultimately included 1810 neonates from 1401 cycles using the EFL protocol and 2700 neonates from 2129 cycles using the LPS protocol.The main outcome measures are gestational age at delivery, birth weight, and congenital anomaly rate.To assess the influence of various factors on congenital abnormalities, a random-effects logistic regression model was employed.
RESULTS: The EFL and LPS protocols led to similar congenital anomaly rates (1.64% vs. 2.35%, P = 0.149). No significant differences were found between the two groups regarding birth weight and its categories, newborn gender and congenital anomaly rate. The results of the multivariate logistic regression model indicated no association between congenital anomaly and BMI, duration of infertility, treatment protocol, fertilization method, or embryo transfer stage. Compared with singleton pregnancies, the probability of congenital defects in multiple pregnancies was 2.64 times higher (OR: 2.64, 95% CI: 1.72-4.05, P < 0.0001). Newborns with congenital defects were born with a lower gestational age compared with full-term pregnancies.
CONCLUSIONS: In conclusion, the EFL protocol is considered a safe option for ensuring offspring safety, comparable with the LPS protocol; however, multiple pregnancies represent an independent risk factor for congenital abnormalities. This approach can be widely adopted; however, prioritizing single embryo transfers is strongly recommended to minimize the potential risks associated with multiple pregnancies in offspring.
METHODS: We conducted a retrospective cohort study to analyze and compare neonatal data from patients who using EFL or LPS protocols at our center between January 1, 2014, and June 30, 2017. The study ultimately included 1810 neonates from 1401 cycles using the EFL protocol and 2700 neonates from 2129 cycles using the LPS protocol.The main outcome measures are gestational age at delivery, birth weight, and congenital anomaly rate.To assess the influence of various factors on congenital abnormalities, a random-effects logistic regression model was employed.
RESULTS: The EFL and LPS protocols led to similar congenital anomaly rates (1.64% vs. 2.35%, P = 0.149). No significant differences were found between the two groups regarding birth weight and its categories, newborn gender and congenital anomaly rate. The results of the multivariate logistic regression model indicated no association between congenital anomaly and BMI, duration of infertility, treatment protocol, fertilization method, or embryo transfer stage. Compared with singleton pregnancies, the probability of congenital defects in multiple pregnancies was 2.64 times higher (OR: 2.64, 95% CI: 1.72-4.05, P < 0.0001). Newborns with congenital defects were born with a lower gestational age compared with full-term pregnancies.
CONCLUSIONS: In conclusion, the EFL protocol is considered a safe option for ensuring offspring safety, comparable with the LPS protocol; however, multiple pregnancies represent an independent risk factor for congenital abnormalities. This approach can be widely adopted; however, prioritizing single embryo transfers is strongly recommended to minimize the potential risks associated with multiple pregnancies in offspring.
摘要：
背景：促性腺激素激素释放激素激动剂（GnRH-a）已广泛用于辅助生殖技术（ART）中的控制性卵巢刺激。早期卵泡长效GnRH-a长方案（EFL）和黄体期短效GnRH-a长方案（LPS）是常用的GnRH激动剂方案。我们进行了回顾性分析，以评估和比较从EFL和LPS方案出生的后代的先天性异常和安全性。
方法：我们进行了一项回顾性队列研究，以分析和比较2014年1月1日至2017年6月30日在我们中心使用EFL或LPS方案的患者的新生儿数据。该研究最终包括使用EFL方案的1401个周期的1810名新生儿和使用LPS方案的2129个周期的2700名新生儿。主要结局指标是分娩时的胎龄，出生体重,和先天性异常率。评估各种因素对先天性异常的影响，采用随机效应逻辑回归模型.
结果：EFL和LPS方案导致相似的先天性异常率（1.64％vs.2.35%,P=0.149）。两组在出生体重及其类别方面没有发现显着差异，新生儿性别和先天性异常率。多变量logistic回归模型的结果表明先天性异常与BMI之间没有关联，不孕的持续时间，治疗方案,施肥方法,或胚胎移植阶段。与单胎怀孕相比，多胎妊娠发生先天性缺陷的概率是其2.64倍(OR:2.64,95%CI:1.72-4.05,P<0.0001)。与足月妊娠相比，具有先天性缺陷的新生儿出生时的胎龄较低。
结论：结论：EFL协议被认为是确保后代安全的安全选择，与LPS方案相当；然而，多胎妊娠是先天性异常的独立危险因素.这种方法可以被广泛采用；然而，强烈建议优先考虑单胚胎移植，以最大程度地减少与后代多胎妊娠相关的潜在风险。
方法：我们进行了一项回顾性队列研究，以分析和比较2014年1月1日至2017年6月30日在我们中心使用EFL或LPS方案的患者的新生儿数据。该研究最终包括使用EFL方案的1401个周期的1810名新生儿和使用LPS方案的2129个周期的2700名新生儿。主要结局指标是分娩时的胎龄，出生体重,和先天性异常率。评估各种因素对先天性异常的影响，采用随机效应逻辑回归模型.
结果：EFL和LPS方案导致相似的先天性异常率（1.64％vs.2.35%,P=0.149）。两组在出生体重及其类别方面没有发现显着差异，新生儿性别和先天性异常率。多变量logistic回归模型的结果表明先天性异常与BMI之间没有关联，不孕的持续时间，治疗方案,施肥方法,或胚胎移植阶段。与单胎怀孕相比，多胎妊娠发生先天性缺陷的概率是其2.64倍(OR:2.64,95%CI:1.72-4.05,P<0.0001)。与足月妊娠相比，具有先天性缺陷的新生儿出生时的胎龄较低。
结论：结论：EFL协议被认为是确保后代安全的安全选择，与LPS方案相当；然而，多胎妊娠是先天性异常的独立危险因素.这种方法可以被广泛采用；然而，强烈建议优先考虑单胚胎移植，以最大程度地减少与后代多胎妊娠相关的潜在风险。
