不同子宫内膜准备方案对冻融胚胎移植中产科及新生儿并发症的影响：3458 例单胎分娩的回顾性队列研究。
The impact of different endometrial preparation protocols on obstetric and neonatal complications in frozen-thawed embryo transfer: a retrospective cohort study of 3,458 singleton deliveries.
机构信息
Centre for Reproductive Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
出版信息
Reprod Biol Endocrinol. 2022 Sep 22;20(1):141. doi: 10.1186/s12958-022-01009-x.
BACKGROUND
Frozen-thawed embryo transfer (FET) is thought to be associated with obstetric and neonatal complications after in vitro fertilization/intracytoplasmic single sperm injection (IVF/ICSI) treatment. The study aimed to determine whether the endometrial preparation protocol is an influencing factor for these complications.
METHODS
We conducted a retrospective cohort study of 3,458 women who had singleton deliveries after IVF/ICSI-FET treatment at the Centre for Reproductive Medicine of Shanghai First Maternity and Infant Hospital between July 2016 and April 2021. The women were divided into three groups according to the endometrial preparation protocols: 2,029 women with programmed cycles, 959 with natural cycles, and 470 with minimal ovarian stimulation cycles. The primary outcomes were the incidence rates of obstetric and neonatal complications, namely, hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), placenta previa, preterm rupture of membranes (PROM), preterm delivery, postpartum haemorrhage, large for gestational age (LGA), small for gestational age (SGA), and macrosomia.
RESULTS
After adjustments for confounding variables by multivariate logistic regression analysis, the results showed that programmed cycles had an increased risk of HDP (aOR = 1.743; 95% CI, 1.110-2.735; P = 0.016) and LGA (aOR = 1.269; 95% CI, 1.011-1.592; P = 0.040) compared with natural cycles. Moreover, programmed cycles also increased the risk of LGA (aOR = 1.459; 95% CI, 1.083-1.965; P = 0.013) but reduced the risk of SGA (aOR = 0.529; 95% CI, 0.348-0.805; P = 0.003) compared with minimal ovarian stimulation cycles. There were no significant differences between natural cycles and minimal ovarian stimulation cycles.
CONCLUSIONS
During IVF/ICSI-FET treatment, the risk of HDP and LGA was increased in women with programmed cycles. Therefore, for patients with thin endometrium, irregular menstruation or no spontaneous ovulation, minimal ovarian stimulation cycles may be a relatively safer option than programmed cycles.
背景
体外受精/卵胞浆内单精子注射（IVF/ICSI）治疗后，冷冻-解冻胚胎移植（FET）被认为与产科和新生儿并发症有关。本研究旨在确定子宫内膜准备方案是否是这些并发症的影响因素。
方法
我们对 2016 年 7 月至 2021 年 4 月在上海第一妇婴保健院生殖医学中心接受 IVF/ICSI-FET 治疗后单胎分娩的 3458 名妇女进行了回顾性队列研究。根据子宫内膜准备方案将这些妇女分为三组：2029 名程序化周期妇女、959 名自然周期妇女和 470 名微刺激周期妇女。主要结局是产科和新生儿并发症的发生率，包括妊娠高血压疾病（HDP）、妊娠期糖尿病（GDM）、妊娠肝内胆汁淤积症（ICP）、前置胎盘、胎膜早破（PROM）、早产、产后出血、巨大儿（LGA）、小于胎龄儿（SGA）和巨大儿。
结果
多变量 logistic 回归分析调整混杂变量后，结果显示程序化周期与 HDP（aOR=1.743；95%CI，1.110-2.735；P=0.016）和 LGA（aOR=1.269；95%CI，1.011-1.592；P=0.040）的风险增加有关，与自然周期相比。此外，程序化周期还增加了 LGA（aOR=1.459；95%CI，1.083-1.965；P=0.013）的风险，但降低了 SGA（aOR=0.529；95%CI，0.348-0.805；P=0.003）的风险与微刺激周期相比。自然周期和微刺激周期之间无显著差异。
结论
在 IVF/ICSI-FET 治疗中，程序化周期的妇女 HDP 和 LGA 的风险增加。因此，对于薄型子宫内膜、月经不规律或无自发排卵的患者，微刺激周期可能是比程序化周期更安全的选择。
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