Tan Justin, Cerrillo Maria, Cruz Maria, Cecchino Gustavo Nardini, Garcia-Velasco Juan Antonio
Department of Obstetrics and Gynaecology, Children's and Women's Hospital and Health Centre of British Columbia, University of British Columbia, Vancouver, BC V6H3N1, Canada.
IVI-RMA, 28023 Madrid, Spain.
J Clin Med. 2021 Jan 18;10(2):344. doi: 10.3390/jcm10020344.
Given the estrogen-dependence associated with endometriosis, hyper-stimulation associated with assisted reproduction treatment may exacerbate the disease process and adversely affect endometrial receptivity and subsequent implantation. In this way, a freeze-all deferred embryo transfer (ET) approach may benefit patients with endometriosis, although controversy exists regarding the mechanism of endometriosis-associated infertility and benefits of deferred ET on endometrial receptivity. Hence, the purpose of this study was to compare in vitro fertilization (IVF) outcomes in women with endometriosis, diagnosed by histology, undergoing fresh versus deferred-ET after elective cryopreservation. Of the 728 women included, no significant differences were observed in baseline patient characteristics and response to gonadotrophin stimulation between fresh and deferred ET groups. Furthermore, no significant differences in implantation rate (49.7 vs. 49.9%, = 0.73), clinical pregnancy rate (40.9 vs. 39.9%, = 0.49), and miscarriage rate (9.4 vs. 9.9%, = 0.63) were observed between fresh and deferred ET groups, respectively. Hence, contrary to previous studies, our results suggest that a deferred ET "freeze-all" IVF strategy does not improve early pregnancy outcomes among women with endometriosis. However, prospective studies are required to validate these findings and further insight into the etiology and pathogenesis of endometriosis-associated infertility are necessary to optimize IVF protocols in this population.
鉴于子宫内膜异位症与雌激素依赖有关，辅助生殖治疗相关的过度刺激可能会加剧疾病进程，并对子宫内膜容受性和随后的着床产生不利影响。通过这种方式，全冻胚延迟胚胎移植（ET）方法可能对子宫内膜异位症患者有益，尽管关于子宫内膜异位症相关不孕症的机制以及延迟胚胎移植对子宫内膜容受性的益处仍存在争议。因此，本研究的目的是比较经组织学诊断为子宫内膜异位症的女性在选择性冷冻保存后进行新鲜胚胎移植与延迟胚胎移植的体外受精（IVF）结果。在纳入的728名女性中，新鲜胚胎移植组和延迟胚胎移植组在基线患者特征和对促性腺激素刺激的反应方面未观察到显著差异。此外，新鲜胚胎移植组和延迟胚胎移植组之间的着床率（49.7%对49.9%，P = 0.73）、临床妊娠率（40.9%对39.9%，P = 0.49）和流产率（9.4%对9.9%，P = 0.63）分别也未观察到显著差异。因此，与先前的研究相反，我们的结果表明，延迟胚胎移植的“全冻胚”IVF策略并不能改善子宫内膜异位症女性的早期妊娠结局。然而，需要前瞻性研究来验证这些发现，并且有必要进一步深入了解子宫内膜异位症相关不孕症的病因和发病机制，以优化该人群的IVF方案。
