高反应患者行冻融胚胎移植与延迟冻融胚胎移植的效果比较：冻存所有胚胎周期。
Effects of immediate versus delayed frozen embryo transfer in high responder patients undergoing freeze-all cycles.
机构信息
Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
出版信息
BMC Pregnancy Childbirth. 2021 Jun 28;21(1):455. doi: 10.1186/s12884-021-03919-x.
BACKGROUND
Frozen embryo transfer (FET) can greatly improve the pregnancy outcomes for high responder patients. However, it is not known whether the timing of FET is a risk factor on pregnancy outcomes in high responder patients undergoing freeze-all cycles.
METHODS
A retrospective cohort study to compare the pregnancy outcomes of the immediate and delayed FET groups in high responder patients undergoing freeze-all cycles. The two groups were defined as that FET took place either within the first menstrual cycle following oocyte retrieval or afterwards. Propensity score matching was used to make the potential risk factors of the two groups comparable. Multivariable regression analysis was used to study the effect of the timing of FET on pregnancy outcomes in the entire cohort and propensity score-matched cohort, even in different controlled ovarian hyperstimulation protocol cohorts as subgroup analysis.
RESULTS
We obtained 1130 patients in immediate FET group and 998 patients in delayed FET group, and the average age of the two groups were 30.30 and 30.63. We showed that the immediate FET group were equivalent to delayed FET group in the entire cohort [clinical pregnancy rate (CPR), 61.0% versus 63.4%, adjusted odd ratio (OR), 0.939, 95% confidence interval (CI), 0.781-1.129; spontaneous abortion rate (SAR), 10.1% versus 12.6%, adjusted OR, 0.831, 95% Cl (0.628-1.098); live birth rate (LBR), 49.9% versus 49.2%, adjusted OR, 1.056, 95% Cl (0.883-1.263)]. The same results were obtained by χ test in the propensity score-matched cohort (CPR, 60.5% versus 63.5%; SAR, 11.6% versus 12.3%; LBR, 48% versus 49.3%) (P > 0.05). Subgroup analysis indicated that pregnancy outcomes of immediate FET were no difference to delayed FET in gonadotropin-releasing hormone agonist (GnRH-a) protocol (P > 0.05). The SAR of the immediate FET group were lower than that of the delayed FET group in GnRH antagonist protocol (adjusted OR, 0.645, 95% CI, 0.430-0.966) (P < 0.05), no differences were observed in CPR and LBR (P > 0.05).
CONCLUSIONS
The pregnancy outcomes of immediate FET were no difference to delayed FET in high responder population undergoing freeze-all cycles.
背景
冻融胚胎移植（FET）可以极大地提高高反应患者的妊娠结局。然而，在进行全冷冻周期的高反应患者中，FET 的时间是否是妊娠结局的一个风险因素尚不清楚。
方法
本回顾性队列研究比较了全冷冻周期中高反应患者的即刻 FET 组和延迟 FET 组的妊娠结局。两组的定义分别为取卵后第一个月经周期内进行 FET 和之后进行 FET。采用倾向评分匹配法使两组的潜在风险因素具有可比性。多变量回归分析用于研究整个队列和倾向评分匹配队列中 FET 时间对妊娠结局的影响，甚至在不同的控制性卵巢过度刺激方案亚组分析中也是如此。
结果
我们纳入了 1130 例即刻 FET 组患者和 998 例延迟 FET 组患者，两组的平均年龄分别为 30.30 岁和 30.63 岁。我们发现，在整个队列中，即刻 FET 组与延迟 FET 组相当[临床妊娠率（CPR），61.0%比 63.4%，调整后的优势比（OR）为 0.939，95%置信区间（CI）为 0.781-1.129；自然流产率（SAR），10.1%比 12.6%，调整后的 OR 为 0.831，95%CI（0.628-1.098）；活产率（LBR），49.9%比 49.2%，调整后的 OR 为 1.056，95%CI（0.883-1.263)]。在倾向评分匹配队列中， χ 检验也得到了相同的结果（CPR，60.5%比 63.5%；SAR，11.6%比 12.3%；LBR，48%比 49.3%）（P > 0.05）。亚组分析表明，在促性腺激素释放激素激动剂（GnRH-a）方案中，即刻 FET 的妊娠结局与延迟 FET 无差异（P > 0.05）。在 GnRH 拮抗剂方案中，即刻 FET 组的 SAR 低于延迟 FET 组（调整后的 OR，0.645，95%CI，0.430-0.966）（P < 0.05），CPR 和 LBR 无差异（P > 0.05）。
结论
在进行全冷冻周期的高反应患者中，即刻 FET 的妊娠结局与延迟 FET 无差异。
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