The Assisted Reproduction Center, Northwest Women's and Children's Hospital, No. 73 Houzai Gate, Xincheng District, Xi'an City, Shaanxi Province, China.
Department of Gynecology, The First Affiliated Hospital of Xi'an Medical College, Xi'an City, Shaanxi Province, China.
Reprod Sci. 2021 Nov;28(11):3155-3163. doi: 10.1007/s43032-021-00603-5. Epub 2021 May 10.
Our objective was to compare the effectiveness of natural cycles (NC), modified natural cycle (mNC), and artificial cycles (AC) in women undergoing frozen-thawed embryo transfer (FET) after in vitro fertilization (IVF). This is a retrospective cohort study analyzing 9733 women undergoing the first cycle of FET over a 3-year period (June 2014-December 2017) at Northwest Women's and Children's Hospital after IVF-ICSI cycles. The type of endometrial preparation was determined by the treating physician's preference, based on patients' characteristics. Women with regular ovulation were allocated to natural cycles (n = 1480) or modified natural cycles (n = 196) when the leading follicle was triggered with hCG, while patients who were reluctant to frequently monitoring or living far from the hospital were allocated to artificial cycles (n = 8057). A logistic regression model was used to assess the association between endometrial preparation and clinical outcomes while adjusting for potential confounders. Live birth rate was primary outcome while miscarriage rate, clinical pregnancy rate, preterm birth rate, and ectopic pregnancy rate were secondary outcomes. In the adjusted model, type of endometrial preparation did not affect live birth (OR, 0.89; 95% CI, 0.74-0.96), clinical pregnancy (OR, 0.93; 95% CI, 0.81-1.06), preterm birth (OR, 1.03; 95% CI, 0.84-1.26), and ectopic pregnancy (OR, 0.73; 95% CI, 0.33-1.59), while AC significantly increased the miscarriage rate (OR, 1.49; 95% CI, 1.17-1.89, P=0.001). In conclusions, in women undergoing FET, natural cycles and artificial cycles resulted in comparable live birth rate while miscarriage rate was higher in artificial cycles.
我们的目的是比较自然周期（NC）、改良自然周期（mNC）和人工周期（AC）在体外受精（IVF）后进行冻融胚胎移植（FET）的女性中的有效性。这是一项回顾性队列研究，分析了 2014 年 6 月至 2017 年 12 月期间在西北妇女儿童医院进行 IVF-ICSI 周期后首次进行 FET 的 9733 名女性。根据患者的特点，由治疗医生根据患者的特点选择子宫内膜准备的类型。有规律排卵的女性在主导卵泡用 hCG 触发时被分配到自然周期（n=1480）或改良自然周期（n=196），而不愿意频繁监测或远离医院的患者被分配到人工周期（n=8057）。使用逻辑回归模型评估在调整潜在混杂因素后，子宫内膜准备与临床结局之间的关联。活产率是主要结局，而流产率、临床妊娠率、早产率和异位妊娠率是次要结局。在调整模型中，子宫内膜准备类型不影响活产率（OR，0.89；95%CI，0.74-0.96）、临床妊娠率（OR，0.93；95%CI，0.81-1.06）、早产率（OR，1.03；95%CI，0.84-1.26）和异位妊娠率（OR，0.73；95%CI，0.33-1.59），而 AC 显著增加了流产率（OR，1.49；95%CI，1.17-1.89，P=0.001）。总之，在接受 FET 的女性中，自然周期和人工周期的活产率相当，而人工周期的流产率更高。
