Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.
Department "Stress oxydant, prolifération cellulaire et inflammation", Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
PLoS One. 2018 Apr 9;13(4):e0194800. doi: 10.1371/journal.pone.0194800. eCollection 2018.
Controlled ovarian stimulation in assisted reproduction technology (ART) may alters endometrial receptivity by an advancement of endometrial development. Recently, technical improvements in vitrification make deferred frozen-thawed embryo transfer (Def-ET) a feasible alternative to fresh embryo transfer (ET). In endometriosis-related infertility the eutopic endometrium is abnormal and its functional alterations are seen as likely to alter the quality of endometrial receptivity. One question in the endometriosis ART-management is to know whether Def-ET could restore optimal receptivity in endometriosis-affected women leading to increase in pregnancy rates.
To compare cumulative ART-outcomes between fresh versus Def-ET in endometriosis-infertile women.
This matched cohort study compared def-ET strategy to fresh ET strategy between 01/10/2012 and 31/12/2014. One hundred and thirty-five endometriosis-affected women with a scheduled def-ET cycle and 424 endometriosis-affected women with a scheduled fresh ET cycle were eligible for matching. Matching criteria were: age, number of prior ART cycles, and endometriosis phenotype. Statistical analyses were conducted using univariable and multivariable logistic regression models.
135 in the fresh ET group and 135 in the def-ET group were included in the analysis. The cumulative clinical pregnancy rate was significantly increased in the def-ET group compared to the fresh ET group [58 (43%) vs. 40 (29.6%), p = 0.047]. The cumulative ongoing pregnancy rate was 34.8% (n = 47) and 17.8% (n = 24) respectively in the Def-ET and the fresh-ET groups (p = 0.005). After multivariable conditional logistic regression analysis, Def-ET was associated with a significant increase in the cumulative ongoing pregnancy rate as compared to fresh ET (OR = 1.76, CI95% 1.06-2.92, p = 0.028).
Def-ET in endometriosis-affected women was associated with significantly higher cumulative ongoing pregnancy rates. Our preliminary results suggest that Def-ET for endometriosis-affected women is an attractive option that could increase their ART success rates. Future studies, with a randomized design, should be conducted to further confirm those results.
辅助生殖技术（ART）中的控制性卵巢刺激可能通过子宫内膜发育的提前来改变子宫内膜容受性。最近，玻璃化技术的改进使得延迟冷冻-解冻胚胎移植（Def-ET）成为新鲜胚胎移植（ET）的可行替代方案。在子宫内膜异位症相关不孕中，在位内膜异常，其功能改变被认为可能改变子宫内膜容受性的质量。在子宫内膜异位症的 ART 管理中存在一个问题，即知道 Def-ET 是否可以恢复受影响的子宫内膜异位症女性的最佳容受性，从而提高妊娠率。
比较新鲜胚胎移植与延迟冷冻-解冻胚胎移植在子宫内膜异位症不孕患者中的累积 ART 结局。
这项匹配队列研究比较了 2012 年 10 月 1 日至 2014 年 12 月 31 日之间的延迟冷冻-解冻胚胎移植策略与新鲜胚胎移植策略。135 名计划进行延迟冷冻-解冻胚胎移植周期的子宫内膜异位症患者和 424 名计划进行新鲜胚胎移植周期的子宫内膜异位症患者符合匹配条件。匹配标准为：年龄、ART 周期次数和子宫内膜异位症表型。使用单变量和多变量逻辑回归模型进行统计分析。
新鲜胚胎移植组 135 例，延迟冷冻-解冻胚胎移植组 135 例纳入分析。与新鲜胚胎移植组相比，延迟冷冻-解冻胚胎移植组的累积临床妊娠率显著增加[58（43%）比 40（29.6%），p = 0.047]。延迟冷冻-解冻胚胎移植组和新鲜胚胎移植组的累积活产妊娠率分别为 34.8%（n = 47）和 17.8%（n = 24）（p = 0.005）。经过多变量条件逻辑回归分析，与新鲜胚胎移植相比，延迟冷冻-解冻胚胎移植与累积活产妊娠率显著增加相关（OR = 1.76，95%CI95% 1.06-2.92，p = 0.028）。
在子宫内膜异位症患者中，延迟冷冻-解冻胚胎移植与显著较高的累积活产妊娠率相关。我们的初步结果表明，对于子宫内膜异位症患者，延迟冷冻-解冻胚胎移植是一种有吸引力的选择，可能会提高他们的 ART 成功率。未来应该进行随机设计的研究，以进一步证实这些结果。
