背景:促性腺激素释放激素激动剂(GnRHa)预处理是否可以改善冻融胚胎移植(FET)周期的妊娠结局存在争议。不同研究结果的不一致与纳入患者的特征和GnRHa使用方案有关。在这项研究中,我们研究了长效GnRH激动剂预处理在FET周期的早期卵泡期的疗效,并确定了哪些人群适合该方案.
结果:我们回顾性地纳入了GnRHaFET和激素替代治疗(HRT)FET中的630例和1141例患者,2017年10月至2019年3月在一所大学附属的体外受精中心。在月经的第二天或第三天,给予3.75mg亮丙瑞林。14天后,开始HRT用于子宫内膜准备。两组之间在患者特征方面没有观察到显着差异。然而,GnRHaFET组子宫内膜呈三行模式的比例较高(94.8%vs89.6%,p<0.001)在孕酮给药当天,植入增加(35.6%vs29.8%,p=0.005),临床妊娠(49.8%vs43.3%,p=0.008),和活产率(39.4%和33.7%,p=0.016),与子宫内膜厚度相似的HRTFET周期相比,异位妊娠和早期流产率。二元逻辑回归分析显示,与无GnRHa的HRTFET组相比,GnRHaFET组的临床妊娠机会增加(P=0.028,比值比[OR]1.32,95%置信区间[CI]1.03-1.70)和活产(P=0.013,比值比[OR]1.34,95%置信区间[CI]1.06-1.70)。亚组分析后,我们发现GnRHaFET组在年龄<40岁的亚组中显示出较高的活产率,原发性不孕症,多囊卵巢综合征(PCOS),月经不调。
结论:在卵泡早期使用长效GnRHa预处理可提高FET周期的活产率。年龄<40岁,原发性不孕症,PCOS,月经不调是FET周期中GnRHa预处理子宫内膜准备的有效指征。然而,需要进一步的随机对照试验来验证这些结果.
BACKGROUND: Whether pretreatment with gonadotropin-releasing hormone agonist (GnRHa) can improve the pregnancy outcomes in frozen-thawed embryo transfer (FET) cycles is controversial. The inconsistencies in the results of different studies would be related to the characteristics of the included patients and the protocol of GnRHa use. In this study, we investigated the efficacy of pretreatment with a long-acting GnRH agonist in the early follicular phase of FET cycles and determined which population was suitable for the protocol.
RESULTS: We retrospectively included 630 and 1141 patients in the GnRHa FET and hormone replacement treatment (HRT) FET without GnRHa groups respectively, between October 2017 and March 2019 at a university-affiliated in vitro fertilization center. On the second or third day of menstruation, 3.75 mg of leuprorelin was administered. After 14 days, HRT was initiated for endometrial preparation. No significant differences were observed between the two groups in terms of patient characteristics. However, the GnRHa FET group showed a higher percentage of endometrium with a triple line pattern (94.8% vs 89.6%, p < 0.001) on the day of progesterone administration, with increased implantation (35.6% vs 29.8%, p = 0.005), clinical pregnancy (49.8% vs 43.3%, p = 0.008), and live birth rate (39.4% vs 33.7%, p = 0.016), than the HRT FET cycles with similar endometrial thickness, ectopic pregnancy and early miscarriage rates. Binary logistic regression analysis showed the GnRHa FET group to be associated with an increased chance of clinical pregnancy (P=0.028, odds ratio [OR] 1.32, 95% confidence interval [CI] 1.03-1.70) and live birth (P=0.013, odds ratio [OR] 1.34, 95% confidence interval [CI] 1.06-1.70) compared to the HRT FET without GnRHa group. After subgroup analysis, we found that the GnRHa FET group showed a significantly higher live birth rate in the subgroups of age < 40 years, primary infertility, with polycystic ovary syndrome (PCOS), and irregular menstruation.
CONCLUSIONS: Pretreatment with a long-acting GnRHa during the early follicular phase improved the live birth rate in FET cycles. Age < 40 years, primary infertility, PCOS, and irregular menstruation are effective indications for endometrial preparation with GnRHa pretreatment in FET cycles. However, further randomized controlled trials are required to verify these results.