■评估不同卵巢刺激方案对子宫腺肌病不孕妇女体外受精/卵胞浆内单精子注射(IVF/ICSI)结局的影响。
我们在接受IVF/ICSI治疗的子宫腺肌病不孕妇女中进行了一项回顾性队列研究,包括257个新鲜胚胎移植(ET)周期和305个冷冻胚胎移植(FET)周期。在新鲜的ET周期中,超长,长,短,和拮抗剂方案被采用。在FET循环中,患者接受长效GnRH激动剂(GnRHa)预处理与否.主要结局是临床妊娠率(CPR),次要结局包括植入率(IR),流产率(MR),和活产率(LBR)。
■在新鲜的ET循环中,与超长协议相比,IR(49.7%,52.1%对28.2%,P=0.001)和CPR(64.3%,57.4%对35.6%,P=0.004)在短方案中显着降低。同样,与超长协议相比,红外倾角降低(49.7%,52.1%对33.3%)和CPR(57.4%,64.3%对38.2%)存在于拮抗剂方案中,尽管由于Bonferroni方法的严格P调整而未检测到统计学意义(Padj=0.008)。与长协议相比,短协议中的LBR明显下降(48.2%对20.3%,P<0.001)。在FET循环中,无论胚胎的起源,IR没有统计学差异,CPR,LBR。对于≥35岁接受新鲜ET的女性,在超长和长方案中,CPR更高(52.1%,50.0%对20.0%,27.5%,P=0.031)与拮抗剂和短方案相比。对于≥35岁接受FET的女性,与超长和拮抗剂方案相比,具有源自长方案和短方案的胚胎的周期具有较高比例的长效GnRHa预处理(30.4%,30.00对63.9%,51.4%,P=0.009)。IR(61.1%,48.6%对32.6%,25.0%,P=0.020)和CPR(58.3%,48.6%对30.4%,25.0%,P=0.024)在长和短方案中的比率高于超长和拮抗剂方案,但由于严格的Bonferroni方法(Padj=0.008),没有统计学差异得到支持。
■在患有子宫腺肌病的不育女性中,如果计划移植一个新鲜的胚胎,超长或长协议可能是有益的。如果使用拮抗剂和简短的方案,建议冷冻整个胚胎,然后进行FET.在FET循环中,来自不同方案的胚胎对妊娠结局没有影响.
To evaluate the effects of different ovarian stimulation protocols on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in infertile women with adenomyosis.
We carried out a retrospective cohort study among infertile women with adenomyosis receiving IVF/ICSI treatment, including 257 fresh embryo transfer (ET) cycles and 305 frozen embryo transfer (FET) cycles. In fresh ET cycles, ultra-long, long, short, and antagonist protocols were adopted. In FET cycles, patients received long-acting GnRH agonist (GnRHa) pretreatment or not. The primary outcome was clinical pregnancy rate (CPR), and the secondary outcomes included implantation rate (IR), miscarriage rate (MR), and live birth rate (LBR).
In fresh ET cycles, compared with ultra-long and long protocols, IR (49.7%, 52.1% versus 28.2%, P=0.001) and CPR (64.3%, 57.4% versus 35.6%, P=0.004) significantly decreased in the short protocol. Similarly, compared with ultra-long and long protocols, a decreased inclination of IR (49.7%, 52.1% versus 33.3%) and CPR (57.4%, 64.3% versus 38.2%) existed in the antagonist protocol, although no statistical significance was detected because of strict P adjustment of Bonferroni method (Padj=0.008). Compared with long protocol, LBR in short protocol decreased obviously (48.2% versus 20.3%, P<0.001). In FET cycles, no matter which origin of embryos, there were no statistical differences in IR, CPR, and LBR. For women ≥35 years receiving fresh ET, CPR was higher in ultra-long and long protocols (52.1%, 50.0% versus 20.0%, 27.5%, P=0.031) compared to antagonist and short protocols. For women ≥35 years receiving FET, compared with ultra-long and antagonist protocols, cycles with embryos originating from long and short protocols had higher proportions of long-acting GnRHa pretreatment (30.4%,30.00 versus 63.9%, 51.4%, P=0.009). IR (61.1%, 48.6% versus 32.6%, 25.0%, P=0.020) and CPR (58.3%, 48.6% versus 30.4%, 25.0%, P=0.024) in long and short protocols were higher than rates of ultra-long and antagonist protocols, but no statistical differences were supported because of strict Bonferroni method (Padj=0.008).
In infertile women with adenomyosis, if a fresh embryo was planned for transfer, an ultra-long or long protocol might be beneficial. If antagonist and short protocols were used, whole embryos frozen followed by FET was recommended. In FET cycles, embryos derived from different protocols had no impact on pregnancy outcomes.