Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Histology, Embryology, Genetics and Developmental Biology, Shanghai Key Laboratory for Reproductive Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Acta Obstet Gynecol Scand. 2020 Oct;99(10):1303-1310. doi: 10.1111/aogs.13863. Epub 2020 Apr 20.
The association between the mode of previous delivery and subsequent success of assisted reproductive treatment has been poorly understood. By mitigating the detrimental effect of supraphysiologic estradiol levels on endometrial receptivity, a freeze-all strategy provides a novel model to investigate the sole impact of a prior cesarean delivery (CD) on embryo transfer outcomes.
This single-center retrospective cohort study included 2660 patients who underwent their first frozen-thawed embryo transfer cycles after a freeze-all policy from January 2013 to December 2018. Patients with a history of live birth by CD were assigned to the CD group, and those with only vaginal delivery (VD) were categorized into the VD group. The primary outcome measure was live birth. Baseline characteristics of the two groups were balanced by propensity score matching in a ratio of 1:1. Univariate and multivariate logistic regression analyses were performed using the after-matching data.
Compared with the VD group, the rates of clinical pregnancy (38.3% vs 44.5%; P = .005) and live birth (27.5% vs 33.4%; P = .003) were significantly lower in women with a history of CD. When adjusted for a number of major confounding factors, the negative association between a prior CD and frozen-thawed embryo transfer success was maintained, with the adjusted odds ratio (OR) being 0.80 (95% CI 0.66-0.96) and 0.78 (95% CI 0.63-0.95) for clinical pregnancy and live birth, respectively. Furthermore, a CD history conferred a marginally increased risk of early miscarriage (crude OR 1.48, 95% CI 1.04-2.11; adjusted OR 1.47, 95% CI 1.01-2.14), whereas the odds of multiple and ectopic pregnancy did not show significant differences before and after adjustment.
A prior CD was associated with a decreased chance of live birth and an increased risk of early miscarriage in frozen-thawed embryo transfer cycles.
既往分娩方式与辅助生殖治疗后续成功之间的关联尚未得到充分理解。通过减轻超生理雌二醇水平对子宫内膜容受性的不利影响，冻融胚胎移植结局的研究提供了一种新的模型来研究单纯剖宫产史（CD）对胚胎移植结局的影响。
本单中心回顾性队列研究纳入了 2013 年 1 月至 2018 年 12 月期间接受冻融胚胎移植周期的 2660 名患者。有 CD 活产史的患者被分配到 CD 组，只有阴道分娩（VD）的患者被归入 VD 组。主要结局指标为活产。采用倾向评分匹配（1:1）平衡两组的基线特征。使用匹配后数据进行单因素和多因素逻辑回归分析。
与 VD 组相比，CD 组的临床妊娠率（38.3% vs 44.5%；P=0.005）和活产率（27.5% vs 33.4%；P=0.003）明显较低。在校正了多个主要混杂因素后，剖宫产史与冻融胚胎移植结局之间的负相关关系仍然存在，校正后的比值比（OR）分别为 0.80（95%CI 0.66-0.96）和 0.78（95%CI 0.63-0.95）。此外，剖宫产史史使早期流产的风险略有增加（粗 OR 1.48，95%CI 1.04-2.11；校正 OR 1.47，95%CI 1.01-2.14），而多胎和异位妊娠的几率在调整前后均无显著差异。
在冻融胚胎移植周期中，既往剖宫产与活产率降低和早期流产风险增加相关。
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