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刺激 IVF 周期后即刻与延迟转移对冻融胚胎移植周期持续妊娠率影响的比较:一项随机对照试验研究方案。

Comparison of the effect of immediate versus delayed transfer following a stimulated IVF cycle on the ongoing pregnancy rate of frozen-thawed embryo transfer cycles: a study protocol for a randomised controlled trial.

机构信息

Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.

Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.

出版信息

BMJ Open. 2018 May 17;8(5):e020507. doi: 10.1136/bmjopen-2017-020507.

DOI:10.1136/bmjopen-2017-020507
PMID:29773699
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5961571/
Abstract

INTRODUCTION

Frozen-thawed embryo transfer (FET) has become an increasingly important part of in-vitro fertilisation (IVF) treatment. Currently, there is still no good scientific evidence to support when to perform FET following a stimulated IVF cycle. Since all published studies are retrospective and the findings are contradictory, a randomised controlled study is needed to provide Level 1 evidence to guide the clinical practice.

METHODS/ANALYSIS: This is a randomised controlled trial. A total of 724 women undergoing the first FET following ovarian stimulation in IVF will be enrolled and randomised according to a computer-generated randomisation list to either (1) the immediate group in which FET will be performed in the first cycle following the stimulated IVF cycle or (2) the delayed group in which FET will be performed at least in the second cycle following the stimulated IVF cycle. The primary outcome is the ongoing pregnancy defined as a viable pregnancy beyond 12 weeks' gestation.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Ethics Committee of Assisted Reproductive Medicine in Shanghai JiAi Genetics & IVF Institute (JIAI E2017-12) and from the Institutional Review Board of the University of Hong Kong Hospital Authority Hong Kong West Cluster (UW 17-371). A written informed consent will be obtained from each woman before any study procedure is performed, according to good clinical practice. The results of this trial will be disseminated in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT03201783;Pre-results.

摘要

简介

冻融胚胎移植(FET)已成为体外受精(IVF)治疗中越来越重要的一部分。目前,仍然没有良好的科学证据支持在刺激 IVF 周期后何时进行 FET。由于所有已发表的研究都是回顾性的,而且研究结果相互矛盾,因此需要进行随机对照研究,以提供 1 级证据来指导临床实践。

方法/分析:这是一项随机对照试验。共纳入 724 名接受 IVF 刺激后首次 FET 的女性,并根据计算机生成的随机分配表将其随机分为(1)立即组,即刺激 IVF 周期后的第一个周期进行 FET;或(2)延迟组,即刺激 IVF 周期后的至少第二个周期进行 FET。主要结局是持续妊娠,定义为超过 12 周妊娠的存活妊娠。

伦理和传播

上海集爱遗传与不育诊疗中心辅助生殖医学伦理委员会(JAI E2017-12)和香港大学医院管理局香港西联网机构审查委员会(UW 17-371)已批准该研究的伦理审查,并已获得每位女性的书面知情同意书,根据良好的临床实践进行任何研究程序。该试验的结果将在同行评议的期刊上发表。

试验注册号

NCT03201783;预结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/5961571/099dc73b0d94/bmjopen-2017-020507f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/5961571/099dc73b0d94/bmjopen-2017-020507f01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dd67/5961571/099dc73b0d94/bmjopen-2017-020507f01.jpg

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本文引用的文献

1
Cryopreserved embryo transfer: adjacent or non-adjacent to failed fresh long GnRH-agonist protocol IVF cycle.冷冻胚胎移植:与失败的新鲜长效促性腺激素释放激素激动剂方案体外受精周期相邻或不相邻。
Reprod Biomed Online. 2017 Mar;34(3):267-273. doi: 10.1016/j.rbmo.2016.11.013. Epub 2016 Dec 16.
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There is no evidence that the time from egg retrieval to embryo transfer affects live birth rates in a freeze-all strategy.没有证据表明在全冷冻策略中,从取卵到胚胎移植的时间会影响活产率。
Hum Reprod. 2017 Feb;32(2):368-374. doi: 10.1093/humrep/dew306. Epub 2016 Dec 16.
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The effect of an immediate frozen embryo transfer following a freeze-all protocol: a retrospective analysis from two centres.
卵裂期冻融胚胎移植可在采用全胚冷冻策略后的第一个月经周期内进行,且不会对活产率产生不利影响:一项符合STROBE标准的回顾性研究。
Medicine (Baltimore). 2019 Sep;98(38):e17329. doi: 10.1097/MD.0000000000017329.
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Flexible Low-Dose GnRH Antagonist Protocol Is Effective in Patients With Sufficient Ovarian Reserve in IVF.灵活低剂量促性腺激素释放激素拮抗剂方案对体外受精中卵巢储备充足的患者有效。
Front Endocrinol (Lausanne). 2018 Dec 19;9:767. doi: 10.3389/fendo.2018.00767. eCollection 2018.
冻存全部胚胎方案后进行即时冻融胚胎移植的效果:来自两个中心的回顾性分析。
Hum Reprod. 2016 Nov;31(11):2541-2548. doi: 10.1093/humrep/dew194. Epub 2016 Sep 8.
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Fertil Steril. 2016 May;105(5):1202-1207.e1. doi: 10.1016/j.fertnstert.2015.12.140. Epub 2016 Jan 21.
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A fresh look at the freeze-all protocol: a SWOT analysis.对全冻方案的新审视:SWOT分析
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Hum Reprod. 2015 Mar;30(3):684-91. doi: 10.1093/humrep/deu362. Epub 2015 Jan 12.
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Cryopreservation and delayed embryo transfer-assisted reproductive technology registry and reporting implications.冷冻保存和延迟胚胎移植辅助生殖技术登记和报告的影响。
Fertil Steril. 2014 Jul;102(1):27-31. doi: 10.1016/j.fertnstert.2014.04.048. Epub 2014 Jun 4.
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Why we should transfer frozen instead of fresh embryos: the translational rationale.为什么我们应该移植冷冻胚胎而不是新鲜胚胎:转化的基本原理。
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Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization: a prospective randomized trial comparing fresh and frozen-thawed embryo transfer in normal responders.体外受精卵巢刺激后子宫内膜容受性受损的证据:正常反应者中比较新鲜和冷冻胚胎移植的前瞻性随机试验。
Fertil Steril. 2011 Aug;96(2):344-8. doi: 10.1016/j.fertnstert.2011.05.050. Epub 2011 Jul 6.