■临床妊娠丢失(CPL)后的最佳妊娠间隔(IPI)仍存在争议。很少有研究讨论在体外受精(IVF)治疗期间在前CPL后IPI的作用。
■评估前一次CPL后不同IPI长度与下一次冷冻胚胎移植(FET)的妊娠结局之间的关联。
■这项回顾性队列研究使用中国山东大学生殖医学中心的数据进行。该研究包括在2017年7月1日至2022年6月30日之间进行冻融囊胚移植的妇女,这些妇女在IVF治疗期间进行CPL治疗后的1年内。所有参与者于2023年3月31日完成了妊娠结局的随访。数据分析于2023年4月至5月进行。
■妊娠间隔长度小于3个月,3至6个月以内,或6至12个月。
■结果包括活产,概念,临床妊娠,怀孕失败,早产,胎龄小或大,低出生体重。采用多变量logistic回归分析,通过调整比值比(AORs)评估IPI与妊娠结局之间的关系。
■这项研究包括2433名女性(平均[SD]年龄,31.8[4.6]年)接受IVF治疗的患者。有338名女性(13.9%)的IPI少于3个月,1347(55.4%),IPI为3至6个月,和748(30.7%),IPI为6至12个月。3组的中位数(IQR)IPI长度为77(65-85),128(109-152),和234(202-288)天,分别。与6至12个月的IPI相比,较短的IPIs(<3和3至<6个月)与临床妊娠几率降低相关(AOR,0.70[95%CI,0.53-0.92]和0.79[0.65-0.95]),活产(AOR,0.64[95%CI,0.48-0.85]和0.74[0.61-0.90]),和健康的活产(AOR,0.63[95%CI,0.46-0.87]和0.79[0.64-0.98])。与IPI为6至12个月的女性相比,IPIs较短(<3个月和3至<6个月)的女性总妊娠丢失的风险较高(AOR,1.87[95%CI,1.31-2.67]和1.29[1.00-1.66],分别)。
■这项研究的结果表明,在前一次CPL后将下一次FET延迟至少6个月与有益的妊娠结局有关,考虑到在IPI较短的女性中观察到实现临床妊娠和活产的可能性降低.需要进一步的前瞻性研究来证实这些发现。
The optimal interpregnancy interval (IPI) after a clinical pregnancy loss (CPL) remains controversial. Few studies have addressed the role of the IPI after a preceding CPL during in vitro fertilization (IVF) treatment.
To evaluate the association between different IPI lengths after a preceding CPL and pregnancy outcomes of the next frozen embryo transfer (FET).
This retrospective cohort study was conducted using data from the Center for Reproductive Medicine of Shandong University in
China. The study included women who underwent frozen-thawed blastocyst transfer between July 1, 2017, and June 30, 2022, within 1 year after a preceding CPL during IVF treatment. Follow-up for pregnancy outcomes was completed for all participants on March 31, 2023. Data analysis was performed from April to May 2023.
Interpregnancy interval length was classified as less than 3 months, 3 to less than 6 months, or 6 to 12 months.
Outcomes included live birth, conception, clinical pregnancy, pregnancy loss, preterm birth, small or large for gestational age, and low birth weight. Multivariable logistic regression analysis was conducted to evaluate the association between IPI and pregnancy outcomes by adjusted odds ratios (AORs).
This study included 2433 women (mean [SD] age, 31.8 [4.6] years) who received IVF treatment. There were 338 women (13.9%) with an IPI of less than 3 months, 1347 (55.4%) with an IPI of 3 to less than 6 months, and 748 (30.7%) with an IPI of 6 to 12 months. The median (IQR) IPI lengths for the 3 groups were 77 (65-85), 128 (109-152), and 234 (202-288) days, respectively. Compared with an IPI of 6 to 12 months, shorter IPIs (<3 and 3 to <6 months) were associated with decreased odds of clinical pregnancy (AOR, 0.70 [95% CI, 0.53-0.92] and 0.79 [0.65-0.95]), live birth (AOR, 0.64 [95% CI, 0.48-0.85] and 0.74 [0.61-0.90]), and healthy live birth (AOR, 0.63 [95% CI, 0.46-0.87] and 0.79 [0.64-0.98]). Compared with women with an IPI of 6 to 12 months, women with shorter IPIs (<3 and 3 to <6 months) had a higher risk of total pregnancy loss (AOR, 1.87 [95% CI, 1.31-2.67] and 1.29 [1.00-1.66], respectively).
The results of this study suggest that delaying the next FET for at least 6 months after a preceding CPL was associated with beneficial pregnancy outcomes, considering that a decreased likelihood of achieving clinical pregnancy and live birth was observed among women with shorter IPIs. Further prospective studies are needed to confirm these findings.