The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, 1305 York Avenue, 6th Floor, New York, NY, 10021, USA.
J Assist Reprod Genet. 2017 Oct;34(10):1325-1331. doi: 10.1007/s10815-017-0983-6. Epub 2017 Jun 24.
The goal of this study was to compare pregnancy outcomes between natural frozen embryo transfer (FET) cycles in ovulatory women and programmed FET cycles in anovulatory women after undergoing in vitro fertilization with preimplantation genetic screening (IVF-PGS).
This was a retrospective cohort study performed at an academic medical center. Patients undergoing single FET IVF-PGS cycles between October 2011 and December 2014 were included. Patients were stratified by type of endometrial replacement: programmed cycles with estrogen/progesterone replacement and natural cycles. IVF-PGS with 24-chromosome screening was performed on all included patients. Those patients with euploid embryos had single embryo transfer in a subsequent FET. The primary study outcome was live birth/ongoing pregnancy rate. Secondary outcomes included implantation, biochemical pregnancy, and miscarriage rates.
One hundred thirteen cycles met inclusion criteria: 65 natural cycles and 48 programmed cycles. The programmed FET group was younger (35.9 ± 4.5 vs. 37.5 ± 3.7, P = 0.03) and had a higher AMH (3.95 ± 4.2 vs. 2.37 ± 2.4, P = 0.045). The groups were similar for BMI, gravidity, parity, history of uterine surgery, and incidence of Asherman's syndrome. There was also no difference in embryo grade at biopsy or transfer, and proportion of day 5 and day 6 transfers. Implantation rates were higher in the natural FET group (0.66 ± 0.48 vs. 0.44 ± 0.50, P = 0.02). There was no difference in the rates of biochemical pregnancy or miscarriage. After controlling for age, live birth/ongoing pregnancy rate was higher in natural FETs with an adjusted odds ratio of 2.68 (95% CI 1.22-5.87).
Natural FET in ovulatory women after IVF-PGS is associated with increased implantation and live birth rates compared to programmed FET in anovulatory women. Further investigation is needed to determine whether these findings hold true in other patient cohorts.
本研究旨在比较体外受精-胚胎移植前遗传学筛查（IVF-PGS）后排卵障碍患者的程序化 FET 周期和自然周期中妊娠结局。
这是一项在学术医疗中心进行的回顾性队列研究。纳入 2011 年 10 月至 2014 年 12 月期间接受单个 FET-IVF-PGS 周期的患者。根据内膜替代类型对患者进行分层：程序化周期采用雌激素/孕激素替代治疗，自然周期。对所有纳入的患者进行 24 染色体筛查。那些具有整倍体胚胎的患者在随后的 FET 中进行单个胚胎移植。主要研究结局为活产/持续妊娠率。次要结局包括着床率、生化妊娠率和流产率。
符合纳入标准的有 113 个周期：65 个自然周期和 48 个程序化周期。程序化 FET 组年龄较小（35.9±4.5 岁 vs. 37.5±3.7 岁，P=0.03），且 AMH 较高（3.95±4.2 vs. 2.37±2.4，P=0.045）。两组的 BMI、孕次、产次、子宫手术史和 Asherman 综合征发生率相似。活检或移植时胚胎分级、第 5 天和第 6 天转移的比例也无差异。自然 FET 组的着床率较高（0.66±0.48 vs. 0.44±0.50，P=0.02）。生化妊娠或流产率无差异。校正年龄后，自然 FET 的活产/持续妊娠率更高，调整后的优势比为 2.68（95%CI 1.22-5.87）。
与排卵障碍患者的程序化 FET 相比，IVF-PGS 后排卵患者的自然 FET 与增加的着床和活产率相关。需要进一步研究以确定这些发现是否适用于其他患者群体。
