Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
PLoS One. 2020 Oct 20;15(10):e0240882. doi: 10.1371/journal.pone.0240882. eCollection 2020.
The optimal timing of frozen-thawed blastocyst transfer following hysteroscopic polypectomy is an important and unanswered clinical question. In this study, we conducted a retrospective survey of cases from an infertility center at an academic hospital. We reviewed the charts of all patients who received in-vitro fertilization and frozen-thawed blastocyst transfers (FBT) at the center from January 2009 to November 2019. One hundred and two patients with prior diagnosis of endometrial polyp that were treated with hysteroscopic polypectomy before received their first FBT at the center were identified as cases. Patients without prior diagnosis of endometrial polyp, and who received their first FBT at the center were defined as controls. Controls were enrolled at a 1-to-1 ratio to the cases. The cases and controls did not show differences in baseline characteristics, endometrial thickness, or the number of good blastocysts transferred. The clinical pregnancy rates and live birth rates were similar. Regarding the optimal interval between polypectomy and FBT, a cut-off of 120 days was identified from the ROC curve. A stratified analysis showed that when FBT was performed within an interval of 120 days after polypectomy, there were higher biochemical pregnancy rates (73.2%, 45.2%; OR 3.3; P = .007) and clinical pregnancy rates (64.8%, 41.9%; OR 2.54; P = .032), when compared with intervals greater than 120 days. There were no significant differences in implantation and live birth rates. In conclusion, pregnancy rates following FBT in patients who had received prior endometrial polypectomy were comparable to pregnancy rates after FBT in patients without endometrial polyp. Subgroup analysis showed that an interval greater than 120 days between hysteroscopic polypectomy and FBT was associated with decreased pregnancy rates. Patients who wish to receive embryo transfer after polypectomy should wait no longer than 120 days.
宫腔镜息肉切除术后行冻融胚胎移植的最佳时机是一个重要且尚未解决的临床问题。在这项研究中，我们对一家学术医院不孕中心的病例进行了回顾性调查。我们回顾了 2009 年 1 月至 2019 年 11 月期间在该中心接受体外受精和冻融胚胎移植（FBT）的所有患者的病历。确定了 102 例经宫腔镜息肉切除术治疗的子宫内膜息肉患者为病例，这些患者在该中心接受了第一次 FBT。将在该中心首次接受 FBT 且无子宫内膜息肉既往诊断的患者定义为对照组。对照组与病例按 1:1 比例纳入。病例和对照组在基线特征、子宫内膜厚度或优质胚胎移植数量方面无差异。临床妊娠率和活产率相似。关于息肉切除和 FBT 之间的最佳间隔时间，从 ROC 曲线中确定了 120 天的截止值。分层分析表明，当 FBT 在息肉切除后 120 天内进行时，生化妊娠率（73.2%，45.2%；OR 3.3；P =.007）和临床妊娠率（64.8%，41.9%；OR 2.54；P =.032）均较高，与间隔大于 120 天相比。植入率和活产率无显著差异。总之，接受过子宫内膜息肉切除术的患者行 FBT 后的妊娠率与未接受过子宫内膜息肉切除术的患者行 FBT 后的妊娠率相当。亚组分析表明，宫腔镜息肉切除术后与 FBT 之间间隔大于 120 天与妊娠率降低相关。希望在息肉切除后接受胚胎移植的患者应等待不超过 120 天。
