Lu Yao, Niu Yichao, Wang Yuan, He Yaqiong, Ding Ying, Lu Xinyuan, Xu Bing, Lindheim Steven R, Sun Yun
Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China.
Front Physiol. 2021 Mar 11;12:576917. doi: 10.3389/fphys.2021.576917. eCollection 2021.
Concern regarding the adverse impact of pretreatment of oral contraceptives (OC) prior to ovarian stimulation for fertilization (IVF) on pregnancy outcome has been debated. We investigated factors that may be associated with live birth rate (LBR) in fresh embryo transfer cycles after OC pretreatment.
A retrospective study was conducted at the Reproductive Center of Ren Ji Hospital, Shanghai, China. 814 women aged 20-35 years undergoing their first autologous IVF cycle and fresh embryo transfer after OC pretreatment were included. Long gonadotropin releasing hormone (GnRH) agonist (a) or GnRH antagonist (ant) protocol was used for ovarian stimulation. Predictive factors for LBR were identified using multivariate logistic regression analysis.
Multivariate logistic regression analysis demonstrated that using GnRH-ant protocol for ovarian stimulation was associated with significantly lower LBR (OR 0.70, 95% CI 0.52-0.93), while endometrial thickness on day of hCG trigger was associated with increased LBR (OR 1.16, 95% CI 1.06-1.27). Despite comparable patients' age, duration of infertility, BMI and basal FSH between GnRH-a and GnRH-ant groups, those using GnRH-ant resulted in significantly lower LBR compared to the GnRH-a group (37.4 vs. 48.5%, = 0.002). Using ROC analysis and a cut-off endometrial thickness of < and ≥ 9.5 mm, those < 9.5 mm using GnRH-ant resulted in significantly lower LBR (28.5 vs. 43.4%, = 0.004), while no differences were noted with an endometrial thickness ≥9.5 mm (49.6 vs. 51.1%, = 0.78).
Live birth was significantly impacted in OC pre-treated GnRH-ant cycles with an endometrial thickness of <9.5 mm on day of hCG trigger. Cryopreservation of all embryos in these cycles should be considered.
关于在体外受精（IVF）卵巢刺激前口服避孕药（OC）预处理对妊娠结局的不利影响一直存在争议。我们调查了OC预处理后新鲜胚胎移植周期中可能与活产率（LBR）相关的因素。
在中国上海仁济医院生殖中心进行了一项回顾性研究。纳入814名年龄在20 - 35岁之间、首次接受自体IVF周期且在OC预处理后进行新鲜胚胎移植的女性。使用长效促性腺激素释放激素（GnRH）激动剂（a）或GnRH拮抗剂（ant）方案进行卵巢刺激。使用多因素逻辑回归分析确定LBR的预测因素。
多因素逻辑回归分析表明，使用GnRH-ant方案进行卵巢刺激与显著较低的LBR相关（OR 0.70，95%CI 0.52 - 0.93），而hCG触发日的子宫内膜厚度与LBR增加相关（OR 1.16，95%CI 1.06 - 1.27）。尽管GnRH-a组和GnRH-ant组患者的年龄、不孕持续时间、BMI和基础FSH相当，但使用GnRH-ant的患者与GnRH-a组相比，LBR显著降低（37.4%对48.5%，P = 0.002）。使用ROC分析并以9.5mm为子宫内膜厚度的截断值，GnRH-ant组中子宫内膜厚度<9.5mm的患者LBR显著较低（28.5%对43.4%，P = 0.004），而子宫内膜厚度≥9.5mm时未观察到差异（49.6%对51.1%，P = 0.78）。
在hCG触发日子宫内膜厚度<9.5mm的OC预处理GnRH-ant周期中，活产受到显著影响。应考虑在这些周期中冷冻保存所有胚胎。
