Kong Na, Liu Jingyu, Zhang Chunxue, Jiang Yue, Zhu Yingchun, Yan Guijun, Sun Haixiang, Huang Chenyang
Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 210008, Nanjing, People's Republic of China.
Center for Molecular Reproductive Medicine, Nanjing University, 210008, Nanjing, China.
BMC Pregnancy Childbirth. 2022 Mar 29;22(1):265. doi: 10.1186/s12884-022-04605-2.
This study aimed to explore the relationship between serum oestrogen (E) levels before endometrial transformation and pregnancy outcomes of hormone replacement therapy-frozen embryo transfer (HRT-FET) cycles, which has been investigated for years without any consensus.
A retrospective cohort study of 10,209 cycles HRT-FET cycles was conducted at the Reproductive Medicine Center of Nanjing Drum Tower Hospital from March 2017 to December 2020. A smooth fitting curve was constructed to identify the relationship between serum E levels before endometrial transformation and the clinical pregnancy rate. Then, threshold and saturation effect analysis was employed to explore the cut-off value of serum E levels. In addition, patients were divided into 2 groups based on their levels of serum E measured before progesterone-induced endometrial transformation: Group 1, < 300 pg/mL (n = 6251) and Group 2, ≥ 300 pg/mL (n = 3958). The clinical pregnancy and miscarriage rates of all groups were compared. Further smooth fitting curve analysis was employed by different subgroups segmented according to different endometrial thicknesses.
When the serum E level was greater than 300 pg/mL, the clinical pregnancy rate decreased significantly (62.9% vs. 59.8%, p < 0.01), but the miscarriage rates were similar (13.5% vs. 15.6%, p = 0.14). While serum E level reached or exceeded 1400 pg/mL, there was no significant correlation between the clinical pregnancy rate and E level. The clinical pregnancy rate reached its higher level at lower E levels, regardless of the different endometrail thicknesses.
Patients with a lower pretransformation serum E level (less than 300 pg/mL) have a higher clinical pregnancy rate and there was no correlation between the clinical pregnancy rate and a higher serum E level (greater than 1400 pg/mL) in HRT-FET cycles.
本研究旨在探讨子宫内膜转化前血清雌激素（E）水平与激素替代疗法 - 冻融胚胎移植（HRT - FET）周期妊娠结局之间的关系，多年来对此进行了研究，但尚未达成共识。
对2017年3月至2020年12月在南京鼓楼医院生殖医学中心进行的10209个HRT - FET周期进行回顾性队列研究。构建平滑拟合曲线以确定子宫内膜转化前血清E水平与临床妊娠率之间的关系。然后，采用阈值和饱和效应分析来探索血清E水平的临界值。此外，根据孕激素诱导子宫内膜转化前测得的血清E水平将患者分为两组：第1组，<300 pg/mL（n = 6251）和第2组，≥300 pg/mL（n = 3958）。比较所有组的临床妊娠率和流产率。根据不同子宫内膜厚度进行细分的不同亚组进一步进行平滑拟合曲线分析。
当血清E水平大于300 pg/mL时，临床妊娠率显著下降（62.9%对59.8%，p < 0.01），但流产率相似（13.5%对15.6%，p = 0.14）。当血清E水平达到或超过1400 pg/mL时，临床妊娠率与E水平之间无显著相关性。无论子宫内膜厚度如何，临床妊娠率在较低E水平时达到较高水平。
在HRT - FET周期中，转化前血清E水平较低（低于300 pg/mL）的患者临床妊娠率较高，而临床妊娠率与较高血清E水平（大于1400 pg/mL）之间无相关性。
