宫腔内人绒毛膜促性腺激素注射是否应在胚胎移植前使用？
Should intrauterine human chorionic gonadotropin infusions ever be used prior to embryo transfer?
机构信息
Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC, 3050, Australia.
Monash University, Wellington Rd & Blackburn Rd, Clayton, VIC, 3800, Australia.
出版信息
J Assist Reprod Genet. 2018 Feb;35(2):273-278. doi: 10.1007/s10815-017-1049-5. Epub 2017 Sep 25.
PURPOSE
The aim of this study was to explore the factors that influence the outcome of intrauterine human chorionic gonadotropin (hCG) infusion at the time of embryo transfer (ET), in particular, the effect of hCG infusions on fresh and frozen embryo transfers (FETs) and whether prior recurrent implantation failure (RIF) impacts upon outcomes.
METHOD
This was a case-control study based on a standardized database from a multi-site in vitro fertilization clinic. The analysis contains 458 cases and 749 matched controls, with an intervention group of those given intrauterine hCG prior to ET and a control group of patients receiving no hCG infusion. Outcomes were defined as clinical pregnancy and live birth rates. Two analyses were performed. The first separated FETs (cases n = 224, controls n = 325) and fresh ETs (cases n = 234, controls n = 424), with outcomes calculated in each group. The second analysis divided patients into those with RIF (cases n = 149, controls n = 200) and those without (cases n = 309, controls n = 549).
RESULTS
Results in fresh ETs demonstrated a 5.8% reduction (adjusted odds ratio (AOR) = 0.60, p = 0.041) in clinical pregnancy rates with the use of intrauterine hCG. In those without defined RIF, clinical pregnancy rates were reduced by 8.1% (AOR = 0.61, p = 0.023) and live birth rates by 7.2% (AOR = 0.56, p = 0.32) with intrauterine hCG use. There were no significant differences in outcomes in FETs and in the RIF cohort.
CONCLUSION
Intrauterine hCG at the time of ET not only seems to have no benefit, but rather a negative effect in fresh ETs and those without RIF.
目的
本研究旨在探讨胚胎移植（ET）时宫腔内人绒毛膜促性腺激素（hCG）输注的影响因素，特别是 hCG 输注对新鲜和冷冻胚胎移植（FET）的影响，以及既往反复着床失败（RIF）是否对结局有影响。
方法
这是一项基于多地点体外受精诊所标准化数据库的病例对照研究。该分析包含 458 例病例和 749 例匹配对照，干预组为 ET 前给予宫腔内 hCG 的患者，对照组为未接受 hCG 输注的患者。结局定义为临床妊娠率和活产率。进行了两项分析。第一项分析将 FET（病例数 n=224，对照组 n=325）和新鲜 ET（病例数 n=234，对照组 n=424）分开，计算每组的结局。第二项分析将患者分为 RIF（病例数 n=149，对照组 n=200）和非 RIF（病例数 n=309，对照组 n=549）两组。
结果
新鲜 ET 结果显示，宫腔内 hCG 的使用使临床妊娠率降低 5.8%（调整后的优势比（AOR）=0.60，p=0.041）。在没有明确 RIF 的患者中，宫腔内 hCG 的使用使临床妊娠率降低 8.1%（AOR=0.61，p=0.023），活产率降低 7.2%（AOR=0.56，p=0.32）。FET 结果和 RIF 队列中没有明显的结局差异。
结论
ET 时宫腔内 hCG 不仅似乎没有益处，反而对新鲜 ET 和无 RIF 的患者有负面影响。
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