黄体期补充额外的 GnRH 激动剂可能会提高 GnRH-HRT 冻融胚胎移植周期的活产率：一项回顾性队列研究。
Additional single dose GnRH agonist during luteal phase support may improve live birth rate in GnRHa-HRT frozen-thawed embryo transfer cycle: a retrospective cohort study.
机构信息
Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 81362, Taiwan.
Department of Obstetrics and Gynecology, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan.
出版信息
BMC Pregnancy Childbirth. 2023 Mar 14;23(1):174. doi: 10.1186/s12884-023-05491-y.
BACKGROUND
GnRH agonist (GnRHa) has been reported to have direct effects and functional roles in the endometrium and embryos. Several meta-analyses have shown that GnRHa administration in the luteal phase improved the live birth rate or pregnancy rate in both fresh and frozen embryo transfer (FET) cycles. The aim of this study was to investigate whether luteal GnRHa administration could also improve in vitro fertilization (IVF) outcomes in patients undergoing hormone replacement therapy (HRT) cycles with GnRHa suppression.
METHODS
The retrospective cohort study included a total of 350 patients undergoing GnRHa-HRT FET cycles. The study group included 179 patients receiving an additional single dose of GnRHa in the luteal phase following embryo transfer. A total of 171 patients in the control group did not receive luteal GnRHa. The baseline and cycle characteristics and reproductive outcomes were compared between the two groups.
RESULTS
Baseline and cycle characteristics were similar between the two groups, except lower AMH levels were found in the luteal GnRHa group than in the control group. The luteal GnRHa group had a significantly higher ongoing pregnancy rate and live birth rate than the control group. The multivariate analysis revealed that luteal GnRHa administration was positively associated with ongoing pregnancy (OR 2.04, 95% CI 1.20-3.47, P = 0.008) and live birth (OR 2.03, 95% CI 1.20-3.45, P = 0.009). When the subgroup of patients with recurrent implantation failure was analyzed, the multivariate analysis also showed that luteal GnRHa administration had beneficial effects on ongoing pregnancy (OR 4.55, 95% CI 1.69-12.30, P = 0.003) and live birth (OR 4.30, 95% CI 1.59-11.65, P = 0.004).
CONCLUSIONS
Our data suggest that the addition of one luteal dose of GnRHa may improve the live birth rate in patients undergoing the GnRHa-HRT protocol.
背景
促性腺激素释放激素激动剂（GnRHa）已被报道在子宫内膜和胚胎中有直接作用和功能作用。几项荟萃分析表明，黄体期给予 GnRHa 可提高新鲜和冷冻胚胎移植（FET）周期的活产率或妊娠率。本研究旨在探讨黄体期给予 GnRHa 是否也可以改善接受促性腺激素释放激素激动剂抑制的激素替代治疗（HRT）周期进行体外受精（IVF）的结局。
方法
这项回顾性队列研究共纳入 350 名接受 GnRHa-HRT FET 周期的患者。研究组 179 名患者在胚胎移植后黄体期接受了单次 GnRHa 额外剂量。对照组 171 名患者未接受黄体期 GnRHa。比较两组的基线和周期特征及生殖结局。
结果
两组的基线和周期特征相似，除了黄体 GnRHa 组的 AMH 水平低于对照组外。黄体 GnRHa 组的持续妊娠率和活产率显著高于对照组。多变量分析显示，黄体期给予 GnRHa 与持续妊娠（OR 2.04，95%CI 1.20-3.47，P=0.008）和活产（OR 2.03，95%CI 1.20-3.45，P=0.009）呈正相关。当分析复发性着床失败的患者亚组时，多变量分析还显示黄体期给予 GnRHa 对持续妊娠（OR 4.55，95%CI 1.69-12.30，P=0.003）和活产（OR 4.30，95%CI 1.59-11.65，P=0.004）有有益的影响。
结论
我们的数据表明，在接受 GnRHa-HRT 方案的患者中，添加一个黄体剂量的 GnRHa 可能会提高活产率。
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