Department of Reproductive Medicine, Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, 3012# Fuqiang Road, Futian District, Shenzhen, Guangdong Province, China.
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands.
Arch Gynecol Obstet. 2021 Sep;304(3):619-626. doi: 10.1007/s00404-021-06014-w. Epub 2021 Mar 6.
Ovulation induction (OI) using letrozole or human menopausal hormone (hMG) is recently developed for endometrium preparation in frozen embryo transfer (FET) cycles. The purpose of this study is to compare the live birth rate of twin pregnancies between modified natural and OI regimens for endometrium preparation in FET cycles.
This study included all consecutive twin pregnancies following FET with modified natural cycle (mNC-FET) or OI (OI-FET) regimen for endometrium preparation between January 2015 to June 2019. Primary outcome was the live birth of at least one twin per pregnancy. Multivariable logistic regression analysis was used to evaluate the potential association of endometrium preparation regimen and live birth. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.
During the study period, 269 twin pregnancies after mNC-FET and 177 twin pregnancies after OI-FET were included. The live birth rate of at least one twin per pregnancy was not significantly different between mNC-FET and OI-FET groups, 92.2% vs 90.4%; aOR 0.65; 95%CI 0.32-1.34. The multivariable regression analysis showed that twin pregnancies after OI-FET had decreased odds for gestational diabetes mellitus (aOR 0.37; 95% CI 0.16-0.87) in comparison to twin pregnancies after mNC-FET. In subgroup analysis, we found that the rate of live birth of at least one twin per pregnancy was significantly higher in OI-FET cycles using letrozole compared to those using hMG (94% vs 83.3%; aOR 3.45; 95%CI 1.24-9.57).
The live birth rate in twin pregnancies after FET is comparable between mNC or OI regimens for endometrium preparation.
使用来曲唑或人绝经后激素（hMG）进行排卵诱导（OI）最近被开发用于冷冻胚胎移植（FET）周期中的子宫内膜准备。本研究的目的是比较改良自然周期（mNC-FET）或 OI（OI-FET）方案用于 FET 周期中子宫内膜准备的双胎妊娠活产率。
本研究包括 2015 年 1 月至 2019 年 6 月期间，使用改良自然周期（mNC-FET）或 OI（OI-FET）方案进行子宫内膜准备的所有连续双胎妊娠。主要结局是每个妊娠至少有一个活产儿。多变量逻辑回归分析用于评估子宫内膜准备方案与活产的潜在关联。计算调整后的优势比（aOR）和 95%置信区间（CI）。
在研究期间，mNC-FET 后有 269 例双胎妊娠，OI-FET 后有 177 例双胎妊娠。每个妊娠至少有一个活产儿的活产率在 mNC-FET 和 OI-FET 组之间无显著差异，分别为 92.2%和 90.4%；aOR 0.65；95%CI 0.32-1.34。多变量回归分析显示，与 mNC-FET 后双胎妊娠相比，OI-FET 后双胎妊娠发生妊娠期糖尿病的几率降低（aOR 0.37；95%CI 0.16-0.87）。在亚组分析中，我们发现使用来曲唑的 OI-FET 周期中每个妊娠至少有一个活产儿的活产率明显高于使用 hMG 的 OI-FET 周期（94%比 83.3%；aOR 3.45；95%CI 1.24-9.57）。
FET 后双胎妊娠的活产率在 mNC 或 OI 方案用于子宫内膜准备时相当。
