Faculté de Santé, Faculté de Médecine Paris Centre, Université de Paris, Paris, France.
Service de Gynécologie-Obstétrique II Et de Médecine de La Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, 75014, Paris, France.
Reprod Sci. 2023 Jul;30(7):2283-2291. doi: 10.1007/s43032-023-01173-4. Epub 2023 Jan 24.
In order to inform patients undergoing ART regarding their chances for motherhood, it seems useful to describe "freeze all" outcomes according to the different potential indications. The goal of this study was to examine the impact of a "freeze-all approach" on the cumulative live birth rate (cLBR) according to the indication. It is a cohort study including women who had undergone ovarian stimulation (OS) using an antagonist protocol with GnRH agonist triggering between 09.2016 and 09.2018 followed by a freeze-all cycle of blastocyst embryos. The ART outcomes were compared between the two main indications of the freeze-all strategy which were in our cohort: risk of ovarian hyperstimulation syndrome (OHSS) and endometriosis. The ART outcomes were also described for the others indications (inadequate endometrium and/or premature progesterone elevation at trigger day, two or more previous ART failures, and autoimmune disease and/or a high risk of thromboembolic disease (AI and/or TE risk)). In total, 658 women were included. The cLBR in the total population was 37.7% (248/658). The cLBR was significantly higher in the "OHSS risk" group (133/281, 47.3%) than in the "endometriosis" group (69/190, 36.3%) (p = 0.017). No significant differences were noted regarding perinatal outcomes, except a significantly higher risk of placenta praevia (PP) observed in the "endometriosis" group (10.1%) (p = 0.002). The "freeze-all approach" yielded good results in terms of the cLBR and especially in case of OHSS risk. These data should be taken into account when informing patients about the ART strategy and their chances of motherhood.
为了让接受辅助生殖技术（ART）的患者了解其生育的可能性，根据不同的潜在指征描述“全部冷冻”的结果似乎很有用。本研究的目的是根据指征检查“全部冷冻”方法对累积活产率（cLBR）的影响。这是一项队列研究，纳入了 2016 年 9 月至 2018 年 9 月期间接受拮抗剂方案促排卵（OS）并使用 GnRH 激动剂触发，随后进行囊胚冷冻的女性。将两种主要的冷冻策略指征（OHSS 风险和子宫内膜异位症）的 ART 结局进行比较。也对其他指征（子宫内膜不足和/或触发日孕激素过早升高、两次或多次既往 ART 失败、自身免疫性疾病和/或血栓栓塞疾病高风险（AI 和/或 TE 风险））的 ART 结局进行了描述。共纳入 658 例患者。总体 cLBR 为 37.7%（248/658）。“OHSS 风险”组（281 例中有 133 例，47.3%）的 cLBR 明显高于“子宫内膜异位症”组（190 例中有 69 例，36.3%）（p=0.017）。围产期结局无显著差异，除“子宫内膜异位症”组胎盘前置（PP）的风险显著升高（10.1%）（p=0.002）。“全部冷冻”方法在 cLBR 方面取得了良好的效果，尤其是在 OHSS 风险方面。在告知患者 ART 策略及其生育可能性时，应考虑这些数据。
