State Key Laboratory of Reproductive Medicine, the Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
Eur J Obstet Gynecol Reprod Biol. 2021 Oct;265:102-106. doi: 10.1016/j.ejogrb.2021.08.018. Epub 2021 Aug 24.
Autoantibodies are associated with worse outcomes in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), including increasing miscarriage rate, lowering pregnancy rate, and lowering delivery rate. However, little is known about improving IVF/ICSI outcomes for autoantibody-positive women, especially in frozen-thawed embryo transfer (FET) cycles. This study aimed to investigate whether pituitary suppression before FET improves the clinical pregnancy rate (CPR) and live birth rate (LBR) for IVF/ICSI women positive for serum autoantibodies.
A total of 181 infertile women positive for serum autoantibodies were recruited, including 65 women receiving GnRHa and hormone replacement therapy protocols (G-HRT group) and 116 women using modified natural cycles (MNC)/mild stimulated cycles (MSC) as FET protocols (MNC/MSC group). The outcomes were compared between two groups, including CPR, implantation rate (IR), miscarriage rate (MR), ongoing pregnancy rate (OPR), LBR, and gestational age (GA). The primary outcome of the study was CPR.
CPR, OPR, and LBR per embryo transferred in the G-HRT groups were significantly higher than those in the MNC/MSC group. No statistically significant differences were observed in the IR and MR. The CPR, IR, MR, OPR, and LBR was 72.23%, 64.00%, 12.77%, 63.07%, and 63.07% in the G-HRT group, respectively, while that was 56.90%, 53.07%, 10.60%, 50.00%, and 50.00% in the MNC/MSC group, respectively. After adjusting for partial potential confounding factors using multiple logistic regression, the type of endometrial preparation is the factor independently associated with enhanced CPR (OR = 0.48, 95%CI: 0.24-0.96, P = 0.039).
The current study showed that prior long-term GnRHa suppression could benefit patients with high serum autoantibody levels during IVF/ICSI FET cycles.
自身抗体与体外受精（IVF）/胞浆内单精子注射（ICSI）的不良结局相关，包括增加流产率、降低妊娠率和降低分娩率。然而，对于自身抗体阳性的女性，特别是在冷冻胚胎移植（FET）周期中，改善 IVF/ICSI 结局的方法知之甚少。本研究旨在探讨 FET 前垂体抑制是否能提高血清自身抗体阳性的 IVF/ICSI 女性的临床妊娠率（CPR）和活产率（LBR）。
共招募了 181 名血清自身抗体阳性的不孕妇女，其中 65 名接受 GnRHa 和激素替代治疗方案（G-HRT 组），116 名使用改良自然周期（MNC）/轻度刺激周期（MSC）作为 FET 方案（MNC/MSC 组）。比较两组的结局，包括 CPR、种植率（IR）、流产率（MR）、持续妊娠率（OPR）、LBR 和孕龄（GA）。本研究的主要结局是 CPR。
G-HRT 组的 CPR、OPR 和 LBR 每胚胎移植显著高于 MNC/MSC 组。IR 和 MR 无统计学差异。G-HRT 组的 CPR、IR、MR、OPR 和 LBR 分别为 72.23%、64.00%、12.77%、63.07%和 63.07%，而 MNC/MSC 组分别为 56.90%、53.07%、10.60%、50.00%和 50.00%。采用多元逻辑回归调整部分潜在混杂因素后，子宫内膜准备类型是与 CPR 提高相关的独立因素（OR=0.48，95%CI：0.24-0.96，P=0.039）。
本研究表明，在 IVF/ICSI FET 周期中，长期使用 GnRHa 抑制可以使高血清自身抗体水平的患者受益。
