背景:冻融胚胎移植(FET)被认为与体外受精/卵胞浆内单精子注射(IVF/ICSI)治疗后的产科和新生儿并发症有关。该研究旨在确定子宫内膜准备方案是否是这些并发症的影响因素。
方法:我们于2016年7月至2021年4月在上海市第一妇婴医院生殖医学中心进行了一项回顾性队列研究,纳入了3,458名接受IVF/ICSI-FET治疗后单胎分娩的妇女。根据子宫内膜准备方案,将妇女分为三组:2,029名具有编程周期的妇女,959具有自然循环,和470与最小的卵巢刺激周期。主要结果是产科和新生儿并发症的发生率,即,妊娠高血压疾病(HDP),妊娠期糖尿病(GDM),妊娠期肝内胆汁淤积症(ICP),前置胎盘,胎膜早破(PROM),早产,产后出血,胎龄大(LGA),小于胎龄(SGA),和巨大儿。
结果:通过多变量逻辑回归分析对混杂变量进行调整后,结果显示,与自然周期相比,程序化周期HDP(aOR=1.743;95%CI,1.110-2.735;P=0.016)和LGA(aOR=1.269;95%CI,1.011-1.592;P=0.040)的风险增加.此外,与最小卵巢刺激周期相比,计划周期也增加了LGA的风险(aOR=1.459;95%CI,1.083-1.965;P=0.013),但降低了SGA的风险(aOR=0.529;95%CI,0.348-0.805;P=0.003).自然周期和最小卵巢刺激周期之间没有显着差异。
结论:在IVF/ICSI-FET治疗期间,在具有程序化周期的女性中,HDP和LGA的风险增加.因此,对于子宫内膜薄的患者,月经不调或无自发排卵,与计划周期相比,最小卵巢刺激周期可能是相对安全的选择.
BACKGROUND: Frozen-thawed embryo transfer (FET) is thought to be associated with obstetric and neonatal complications after in vitro fertilization/intracytoplasmic single sperm injection (IVF/ICSI) treatment. The
study aimed to determine whether the endometrial preparation protocol is an influencing factor for these complications.
METHODS: We conducted a retrospective cohort
study of 3,458 women who had singleton deliveries after IVF/ICSI-FET treatment at the Centre for Reproductive Medicine of Shanghai First Maternity and Infant Hospital between July 2016 and April 2021. The women were divided into three groups according to the endometrial preparation protocols: 2,029 women with programmed cycles, 959 with natural cycles, and 470 with minimal ovarian stimulation cycles. The primary outcomes were the incidence rates of obstetric and neonatal complications, namely, hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), placenta previa, preterm rupture of membranes (PROM), preterm delivery, postpartum haemorrhage, large for gestational age (LGA), small for gestational age (SGA), and macrosomia.
RESULTS: After adjustments for confounding variables by multivariate logistic regression analysis, the results showed that programmed cycles had an increased risk of HDP (aOR = 1.743; 95% CI, 1.110-2.735; P = 0.016) and LGA (aOR = 1.269; 95% CI, 1.011-1.592; P = 0.040) compared with natural cycles. Moreover, programmed cycles also increased the risk of LGA (aOR = 1.459; 95% CI, 1.083-1.965; P = 0.013) but reduced the risk of SGA (aOR = 0.529; 95% CI, 0.348-0.805; P = 0.003) compared with minimal ovarian stimulation cycles. There were no significant differences between natural cycles and minimal ovarian stimulation cycles.
CONCLUSIONS: During IVF/ICSI-FET treatment, the risk of HDP and LGA was increased in women with programmed cycles. Therefore, for patients with thin endometrium, irregular menstruation or no spontaneous ovulation, minimal ovarian stimulation cycles may be a relatively safer option than programmed cycles.