预处理 GnRH-a 的人工周期对 PCOS 患者冻融胚胎移植后妊娠和新生儿结局的影响：一项倾向评分匹配研究。
Effect of artificial cycle with or without GnRH-a pretreatment on pregnancy and neonatal outcomes in women with PCOS after frozen embryo transfer: a propensity score matching study.
机构信息
Department of Epidemiology, School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, 400016, China.
Xinan Gynecological Hospital, Chengdu, 610011, China.
出版信息
Reprod Biol Endocrinol. 2022 Mar 25;20(1):56. doi: 10.1186/s12958-022-00929-y.
BACKGROUND
In frozen embryo transfer (FET), there is limited consensus on the best means of endometrial preparation in terms of the reproductive outcomes in women with polycystic ovary syndrome (PCOS). The present study aimed to compare the pregnancy and neonatal outcomes following artificial cycle FET (AC-FET) with or without gonadotropin-releasing hormone agonist (GnRH-a) pretreatment among women with PCOS.
METHODS
A total of 4503 FET cycles that satisfied the inclusion criteria were enrolled in this retrospective cohort study between 2015 and 2020. The GnRH-a group received GnRH-a pretreatment while the AC-FET group did not. Propensity score matching (PSM) method and multivariate logistic regression analysis were performed to adjust for potential confounding factors.
RESULTS
After PSM, women in the GnRH-a group suffered a significantly lower miscarriage rate (11.2% vs. 17.1%, P = 0.033) and a higher live birth rate (LBR) compared with those in the AC-FET group (63.1% vs. 56.8%, P = 0.043). No differences were observed in the rates of biochemical pregnancy, clinical pregnancy and ectopic pregnancy between the two groups. A higher mean gestational age at birth was observed in the GnRH-a group than in the AC-FET group (39.80 ± 2.01 vs. 38.17 ± 2.13, P = 0.009). The incidence of neonatal preterm birth (PTB) in the GnRH-a group was lower than that in the AC-FET group (7.4% vs. 14.9%, P = 0.009). Singleton newborns conceived after GnRH-a group were more likely to be small for gestational age (SGA) than those born after AC-FET group (16.4% vs. 6.8%, P = 0.009). However, no significant differences were found between the two groups in terms of mean birthweight, apgar score, the rates of macrosomia, large for gestational age and low birth weight.
CONCLUSION(S): In women with PCOS who underwent AC-FET, GnRH-a pretreatment was significantly associated with a higher live birth rate and a reduced risk of neonatal PTB. However, there was a concomitant increase in the risk of developing SGA babies.
背景
在冻融胚胎移植（FET）中，对于多囊卵巢综合征（PCOS）患者，在生殖结局方面，关于子宫内膜准备的最佳方法尚未达成共识。本研究旨在比较接受或不接受促性腺激素释放激素激动剂（GnRH-a）预处理的多囊卵巢综合征患者进行人工周期 FET（AC-FET）后的妊娠和新生儿结局。
方法
本回顾性队列研究纳入了 2015 年至 2020 年间符合纳入标准的 4503 个 FET 周期。GnRH-a 组接受 GnRH-a 预处理，而 AC-FET 组则不接受。采用倾向评分匹配（PSM）法和多因素 logistic 回归分析来调整潜在的混杂因素。
结果
PSM 后，GnRH-a 组的流产率显著低于 AC-FET 组（11.2% vs. 17.1%，P=0.033），活产率高于 AC-FET 组（63.1% vs. 56.8%，P=0.043）。两组间生化妊娠、临床妊娠和异位妊娠率无差异。GnRH-a 组的平均出生孕周大于 AC-FET 组（39.80±2.01 vs. 38.17±2.13，P=0.009）。GnRH-a 组新生儿早产（PTB）发生率低于 AC-FET 组（7.4% vs. 14.9%，P=0.009）。GnRH-a 组出生的单胎新生儿小于胎龄儿（SGA）的发生率高于 AC-FET 组（16.4% vs. 6.8%，P=0.009）。然而，两组间新生儿的平均出生体重、阿普加评分、巨大儿、大于胎龄儿和低出生体重儿的发生率无显著差异。
结论
在接受 AC-FET 的多囊卵巢综合征患者中，GnRH-a 预处理与活产率升高和新生儿 PTB 风险降低显著相关。然而，SGA 婴儿的风险也随之增加。
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