Eslami Moayed Marzieh, Moini Ashraf, Kashani Ladan, Farid Mojtahedi Maryam, Rezaee Tawoos, Tabasizadeh Hamed, Maajani Khadije, Yamini Nazila
Department of Gynecology and Obstetrics, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
Int J Reprod Biomed. 2023 Jul 24;21(6):481-490. doi: 10.18502/ijrm.v21i6.13635. eCollection 2023 Jun.
Selecting a suitable and preferable method for endometrial preparation in frozen embryo transfer (FET) cycles for women with adenomyosis is still challenging in infertility treatment.
To compare 2 artificial endometrial preparation regimens with and without gonadotropin-releasing hormone agonist (GnRHa) pretreatment in women with adenomyosis undergoing FET cycles.
This randomized clinical trial study was conducted on 140 adenomyosis cases who underwent FET cycles at Arash Women's hospital, Tehran, Iran from May 2020 to March 2021. Participants were randomly allocated into hormonal replacement therapy (HRT) and HRT+GnRHa pretreatment groups (n = 70/each). Endometrial preparation with 2-6 mg daily estradiol was started in the HRT+GnRHa group, taking after down-regulation with the GnRHa. Within the HRT group, the same dose of estradiol was commenced within the early follicular stage. The main (chemical and clinical pregnancy rates) and auxiliary results (twin pregnancy, miscarriage, and live birth rates) were compared between groups.
The demographic characteristics and severity of adenomyosis, endometrial thickness, and pattern at starting progesterone administration were similar in the 2 groups, and triple-line endometrium was found to be the dominant pattern in both groups (p = 0.65). No significant differences were observed in chemical, clinical, and twin pregnancy rates as well as miscarriage and live birth rates between groups (p = 0.71, p = 0.81, p = 0.11, and p = 0.84, respectively). However, the total estrogen dose and duration of estrogen consumption were significantly higher in the pretreatment group (p = 0.001, and p = 0.003).
These results indicated that the hormonal endometrial preparation with estrogen and progestin for FET cycles is as efficacious as a protocol involving preceding pituitary suppression with a GnRHa. Further large randomized clinical studies are required to confirm these findings.
对于患有子宫腺肌病的女性，在冷冻胚胎移植（FET）周期中选择一种合适且优选的子宫内膜准备方法在不孕症治疗中仍然具有挑战性。
比较在接受FET周期的子宫腺肌病女性中，2种人工子宫内膜准备方案（有无促性腺激素释放激素激动剂（GnRHa）预处理）的效果。
这项随机临床试验研究于2020年5月至2021年3月在伊朗德黑兰的阿拉什妇女医院对140例接受FET周期的子宫腺肌病患者进行。参与者被随机分为激素替代疗法（HRT）组和HRT+GnRHa预处理组（每组n = 70）。HRT+GnRHa组在使用GnRHa进行降调节后，开始每日服用2 - 6毫克雌二醇进行子宫内膜准备。在HRT组中，在卵泡早期开始使用相同剂量的雌二醇。比较两组的主要结果（化学妊娠率和临床妊娠率）和辅助结果（双胎妊娠、流产和活产率）。
两组患者的人口统计学特征、子宫腺肌病严重程度、子宫内膜厚度以及开始使用孕酮时的内膜形态相似，且两组中三线内膜均为主要形态（p = 0.65）。两组在化学妊娠率、临床妊娠率、双胎妊娠率以及流产率和活产率方面均未观察到显著差异（分别为p = 0.71、p = 0.81、p = 0.11和p = 0.84）。然而，预处理组的总雌激素剂量和雌激素使用持续时间显著更高（p = 0.001和p = 0.003）。
这些结果表明，在FET周期中使用雌激素和孕激素进行激素性子宫内膜准备与使用GnRHa进行垂体预处理的方案效果相同。需要进一步的大型随机临床研究来证实这些发现。
