Department of Obstetrics and Gynaecology, Hangzhou Women's Hospital, No. 369 Kun Peng Road, Zhejiang, 310008, Hangzhou, China.
Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Zhejiang, 310016, Hangzhou, China.
J Assist Reprod Genet. 2021 Aug;38(8):1913-1926. doi: 10.1007/s10815-021-02125-0. Epub 2021 Apr 7.
To compare the effects of different endometrial preparation protocols for frozen-thawed embryo transfer (FET) cycles and present treatment hierarchy.
Systematic review with meta-analysis was performed by electronic searching of MEDLINE, the Cochrane Library, Embase, ClinicalTrials.gov and Google Scholar up to Dec 26, 2020. Randomised controlled trials (RCTs) or observational studies comparing 7 treatment options (natural cycle with or without human chorionic gonadotrophin trigger (mNC or tNC), artificial cycle with or without gonadotropin-releasing hormone agonist suppression (AC+GnRH or AC), aromatase inhibitor, clomiphene citrate, gonadotropin or follicle stimulating hormone) in FET cycles were included. Meta-analyses were performed within random effects models. Primary outcome was live birth presented as odds ratio (OR) with 95% confidence intervals (CIs).
Twenty-six RCTs and 113 cohort studies were included in the meta-analyses. In a network meta-analysis, AC ranked last in effectiveness, with lower live birth rates when compared with other endometrial preparation protocols. In pairwise meta-analyses of observational studies, AC was associated with significant lower live birth rates compared with tNC (OR 0.81, 0.70 to 0.93) and mNC (OR 0.85, 0.77 to 0.93). Women who achieved pregnancy after AC were at an increased risk of pregnancy-induced hypertension (OR 1.82, 1.37 to 2.38), postpartum haemorrhage (OR 2.08, 1.61 to 2.78) and very preterm birth (OR 2.08, 1.45 to 2.94) compared with those after tNC.
Natural cycle treatment has a higher chance of live birth and lower risks of PIH, PPH and VPTB than AC for endometrial preparation in women receiving FET cycles.
比较不同冻融胚胎移植（FET）周期中子宫内膜准备方案的效果，并提出治疗方案的优先顺序。
通过电子检索 MEDLINE、Cochrane 图书馆、Embase、ClinicalTrials.gov 和 Google Scholar，对截至 2020 年 12 月 26 日的文献进行系统评价和荟萃分析。纳入比较 7 种治疗方案（自然周期加或不加人绒毛膜促性腺激素扳机（mNC 或 tNC）、有或无促性腺激素释放激素激动剂抑制的人工周期（AC+GnRH 或 AC）、芳香化酶抑制剂、枸橼酸氯米酚、促性腺激素或卵泡刺激素）的随机对照试验（RCT）或观察性研究。使用随机效应模型进行荟萃分析。主要结局为活产，表现为优势比（OR）及其 95%置信区间（CI）。
26 项 RCT 和 113 项队列研究纳入荟萃分析。在网络荟萃分析中，AC 的效果最差，与其他子宫内膜准备方案相比，活产率较低。在观察性研究的成对荟萃分析中，与 tNC（OR 0.81，0.70 至 0.93）和 mNC（OR 0.85，0.77 至 0.93）相比，AC 与显著较低的活产率相关。与 tNC 相比，接受 AC 治疗后怀孕的女性发生妊娠高血压（OR 1.82，1.37 至 2.38）、产后出血（OR 2.08，1.61 至 2.78）和极早产（OR 2.08，1.45 至 2.94）的风险增加。
与 AC 相比，FET 周期中自然周期治疗有更高的活产机会，且妊娠高血压、产后出血和极早产的风险较低。
