Department of Obstetrics and Gynecology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250001, China; Department of Obstetrics and Gynecology, Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250000, China.
Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan 250001, China.
Reprod Biomed Online. 2020 Sep;41(3):395-401. doi: 10.1016/j.rbmo.2020.04.021. Epub 2020 May 14.
Is there a difference in live birth rate between a freeze-only strategy and fresh embryo transfer, and what is the effect of varying progesterone concentrations on the day of human chorionic gonadotrophin (HCG) administration?
A secondary analysis of data from three randomized trials comparing the live birth rate after elective frozen versus fresh embryo transfer, which respectively enrolled 1508 women with polycystic ovary syndrome, 2157 ovulatory women who underwent cleavage-stage embryo transfer and 1650 ovulatory women who underwent single blastocyst transfer. Women were randomly assigned to the frozen or fresh embryo transfer group in the original trials. The primary outcome was live birth rate after the initial embryo transfer.
The live birth rate after a freeze-only strategy was consistently higher than fresh embryo transfer at any progesterone concentration on the day of HCG administration. Nonetheless, the between-group difference in live birth rate after frozen versus fresh embryo transfer was greater in women with progesterone concentrations ≥1.14 ng/ml (52.7% versus 37.3%, odds ratio (OR) 1.88, 95% confidence interval (CI) 1.55-2.27, P = 7.89 × 10) than in women with progesterone concentrations <1.14 ng/ml (53.3% versus 48.1%, OR 1.23, 95% CI 1.08-1.41, P = 0.002). In women with progesterone concentration ≥1.14 ng/ml, frozen embryo transfer also resulted in higher rates of conception and clinical pregnancy than fresh embryo transfer.
In women with normal or high ovarian response, a freeze-only strategy resulted in a higher live birth rate than fresh embryo transfer, irrespective of progesterone concentration. Moreover, women with progesterone concentration ≥1.14 ng/ml may benefit more from a freeze-only strategy.
仅冷冻策略与新鲜胚胎移植之间的活产率是否存在差异，以及人绒毛膜促性腺激素（hCG）给药日孕酮浓度的变化对活产率有何影响？
对比较选择性冷冻与新鲜胚胎移植后活产率的三项随机试验数据进行二次分析，这些试验分别纳入了 1508 例多囊卵巢综合征患者、2157 例行卵裂期胚胎移植的排卵患者和 1650 例行单囊胚移植的排卵患者。在原始试验中，这些女性被随机分配到冷冻或新鲜胚胎移植组。主要结局是首次胚胎移植后的活产率。
在 hCG 给药日任何孕酮浓度下，仅冷冻策略的活产率始终高于新鲜胚胎移植。然而，在孕酮浓度≥1.14ng/ml 的女性中，冷冻与新鲜胚胎移植后活产率的组间差异较大（52.7%比 37.3%，优势比（OR）1.88，95%置信区间（CI）1.55-2.27，P=7.89×10），而在孕酮浓度<1.14ng/ml 的女性中，差异较小（53.3%比 48.1%，OR 1.23，95%CI 1.08-1.41，P=0.002）。在孕酮浓度≥1.14ng/ml 的女性中，与新鲜胚胎移植相比，冷冻胚胎移植也导致更高的妊娠率和临床妊娠率。
在卵巢反应正常或较高的女性中，无论孕酮浓度如何，仅冷冻策略的活产率均高于新鲜胚胎移植。此外，孕酮浓度≥1.14ng/ml 的女性可能更受益于仅冷冻策略。
