Shandong University of Traditional Chinese Medicine, Jinan, China.
Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
BMC Pregnancy Childbirth. 2022 May 7;22(1):394. doi: 10.1186/s12884-022-04728-6.
Previous studies have shown that frozen embryo transfer (FET) resulted in increased live birth rates (LBR) and reduced the risk of ovarian hyperstimulation syndrome (OHSS) than did fresh embryo transfer in women with polycystic ovary syndrome (PCOS). In addition, overweight/obese women with PCOS are at increased risk of subfertility and complications of pregnancy, compared with normal-weight women. The ovarian stimulation and artificial hormone regimes are the two more commonly used endometrial preparation protocols in PCOS patients.This retrospective study aims to compare the pregnancy outcomes of mildly stimulated cycles (mSTC) and artificial cycles (AC) prior to FET in overweight/obese women with PCOS.
A retrospective analysis was conducted in overweight/obese women with PCOS who underwent their first FET cycles from January 2018 to December 2020. Two endometrial preparation protocols were used: the mildly stimulated cycles (N = 173) and the artificial cycles (N = 507). All pregnancy outcomes were analyzed by Student's t-test, Chi-square (χ) statistics and multivariable logistic regression analyses.
This study enrolled 680 cases of FET cycles. The mSTC group exhibited significantly higher LBR compared with the AC group (49.7% vs. 41.0%; P = 0.046), while the rate of miscarriage was significantly lower (6.4% vs. 23.0%; P < 0.001). No statistically significant differences were observed in positive pregnancy rate (57.8% vs. 60.0%, P = 0.618), clinical pregnancy rate (54.3% vs. 55.6%, P = 0.769), and ectopic pregnancy rate (2.1% vs. 3.2%, P = 0.860) between two groups. After adjusting for possible confounding factors, multivariate logistic regression analysis also yielded similar results.
For overweight/obese women with PCOS, mSTC-FET demonstrated a higher LBR and a lower pregnancy loss rate than that in the AC-FET. When considering the most cost-effective treatment with the least adverse effects on patients, the mSTC for FET endometrial preparation may be considered. To corroborate our findings, additional prospective randomized clinical trials with larger sample sizes are required.
先前的研究表明，与新鲜胚胎移植相比，冷冻胚胎移植（FET）可提高多囊卵巢综合征（PCOS）患者的活产率（LBR）并降低卵巢过度刺激综合征（OHSS）的风险。此外，与正常体重的女性相比，超重/肥胖的 PCOS 女性的不孕风险和妊娠并发症风险增加。在 PCOS 患者中，卵巢刺激和人工激素方案是两种更常用的子宫内膜准备方案。本回顾性研究旨在比较超重/肥胖的 PCOS 患者 FET 前轻度刺激周期（mSTC）和人工周期（AC）的妊娠结局。
对 2018 年 1 月至 2020 年 12 月期间进行首次 FET 周期的超重/肥胖的 PCOS 患者进行回顾性分析。使用两种子宫内膜准备方案：轻度刺激周期（N=173）和人工周期（N=507）。通过学生 t 检验、卡方（χ）检验和多变量逻辑回归分析来分析所有妊娠结局。
本研究共纳入 680 例 FET 周期。mSTC 组的 LBR 显著高于 AC 组（49.7%比 41.0%；P=0.046），而流产率显著降低（6.4%比 23.0%；P<0.001）。两组之间的阳性妊娠率（57.8%比 60.0%；P=0.618）、临床妊娠率（54.3%比 55.6%；P=0.769）和异位妊娠率（2.1%比 3.2%；P=0.860）均无统计学差异。调整可能的混杂因素后，多变量逻辑回归分析也得出了相似的结果。
对于超重/肥胖的 PCOS 患者，mSTC-FET 显示出比 AC-FET 更高的 LBR 和更低的妊娠丢失率。在考虑对患者影响最小的最具成本效益的治疗方法时，mSTC 可能适用于 FET 子宫内膜准备。为了证实我们的研究结果，还需要开展更多具有更大样本量的前瞻性随机临床试验。
