改良自然周期冻融胚胎移植：有自发黄体生成素峰与无自发黄体生成素峰排卵妇女妊娠结局的回顾性分析。
Frozen-thawed embryo transfer in modified natural cycles: a retrospective analysis of pregnancy outcomes in ovulatory women with vs. without spontaneous luteinizing hormone surge.
机构信息
School of Life Sciences and Technology, Tongji University, Shanghai, China.
Department of Reproductive Medicine Center, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
出版信息
BMC Pregnancy Childbirth. 2022 Nov 4;22(1):814. doi: 10.1186/s12884-022-05161-5.
BACKGROUND
Timing of frozen embryo transfer (FET) in natural endometrial preparation cycles is often based on luteinizing hormone (LH) surge. However, some patients do not show spontaneous LH surge despite follicular maturation. The objective of this study was to evaluate the impact of spontaneous LH surge on pregnancy outcomes in modified natural cycles (mNC).
METHODS
This retrospective analysis included 1897 FET cycles with modified natural endometrial preparation in normo-ovulatory women between January 1, 2015, to December 31, 2019, at our center: 920 cycles with spontaneous LH surge (≥ 20 IU/L) and 977 without. For cleavage embryos, FET was conducted 4 and 5 days after hCG injection in women with and without LH surge, respectively. For blastocysts, FET was conducted 6 and 7 days after hCG injection in women with and without LH surge, respectively. Multivariate regression was conducted to examine the factors associated with live birth.
RESULTS
Live birth rate was 43.7% in patients with spontaneous LH surge vs. 43.8% in women without LH surge (P = 0.961). The two groups also had similar implantation rate (36.2% vs. 36.7%, P = 0.772), biochemical pregnancy rate (54.8% vs. 55.4%, P = 0.796) and clinical pregnancy rate (50.9% vs. 51.7%, P = 0.721). In multivariate regression, live birth was not associated with LH surge (aOR, 0.947, 95% CI, 0.769, 1.166).
CONCLUSION
Pregnancy outcomes were similar in mNC-FET in cycles with vs. without spontaneous LH surge if FET timing is adjusted.
背景
在自然子宫内膜准备周期中，冷冻胚胎移植（FET）的时间通常基于黄体生成素（LH）峰。然而，尽管卵泡成熟，有些患者仍不会出现自发的 LH 峰。本研究旨在评估自然周期改良（mNC）中自发 LH 峰对妊娠结局的影响。
方法
本回顾性分析包括 2015 年 1 月 1 日至 2019 年 12 月 31 日期间在我们中心接受改良自然子宫内膜准备的 1897 例正常排卵妇女的 FET 周期：920 例有自发 LH 峰（≥20 IU/L），977 例无自发 LH 峰。对于卵裂胚胎，有 LH 峰和无 LH 峰的妇女分别在 hCG 注射后 4 天和 5 天行 FET。对于囊胚，有 LH 峰和无 LH 峰的妇女分别在 hCG 注射后 6 天和 7 天行 FET。采用多变量回归分析来检查与活产相关的因素。
结果
有自发 LH 峰的患者活产率为 43.7%，无 LH 峰的患者为 43.8%（P=0.961）。两组的种植率（36.2% vs. 36.7%，P=0.772）、生化妊娠率（54.8% vs. 55.4%，P=0.796）和临床妊娠率（50.9% vs. 51.7%，P=0.721）也相似。多变量回归分析显示，活产与 LH 峰无关（调整后优势比，0.947，95%置信区间，0.769，1.166）。
结论
如果调整 FET 时间，mNC-FET 中有无自发 LH 峰的周期妊娠结局相似。
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