卵巢刺激方案对子宫腺肌病患者辅助生殖技术结局的影响：一项回顾性队列研究。
Effects of ovarian stimulation protocols on outcomes of assisted reproductive technology in adenomyosis women: a retrospective cohort study.
机构信息
Center for Reproductive Medicine, the Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
出版信息
Front Endocrinol (Lausanne). 2023 Aug 17;14:1198779. doi: 10.3389/fendo.2023.1198779. eCollection 2023.
OBJECTIVE
To evaluate the effects of different ovarian stimulation protocols on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in infertile women with adenomyosis.
METHODS
We carried out a retrospective cohort study among infertile women with adenomyosis receiving IVF/ICSI treatment, including 257 fresh embryo transfer (ET) cycles and 305 frozen embryo transfer (FET) cycles. In fresh ET cycles, ultra-long, long, short, and antagonist protocols were adopted. In FET cycles, patients received long-acting GnRH agonist (GnRHa) pretreatment or not. The primary outcome was clinical pregnancy rate (CPR), and the secondary outcomes included implantation rate (IR), miscarriage rate (MR), and live birth rate (LBR).
RESULTS
In fresh ET cycles, compared with ultra-long and long protocols, IR (49.7%, 52.1% versus 28.2%, P=0.001) and CPR (64.3%, 57.4% versus 35.6%, P=0.004) significantly decreased in the short protocol. Similarly, compared with ultra-long and long protocols, a decreased inclination of IR (49.7%, 52.1% versus 33.3%) and CPR (57.4%, 64.3% versus 38.2%) existed in the antagonist protocol, although no statistical significance was detected because of strict P adjustment of Bonferroni method (P=0.008). Compared with long protocol, LBR in short protocol decreased obviously (48.2% versus 20.3%, P<0.001). In FET cycles, no matter which origin of embryos, there were no statistical differences in IR, CPR, and LBR. For women ≥35 years receiving fresh ET, CPR was higher in ultra-long and long protocols (52.1%, 50.0% versus 20.0%, 27.5%, P=0.031) compared to antagonist and short protocols. For women ≥35 years receiving FET, compared with ultra-long and antagonist protocols, cycles with embryos originating from long and short protocols had higher proportions of long-acting GnRHa pretreatment (30.4%,30.00 versus 63.9%, 51.4%, P=0.009). IR (61.1%, 48.6% versus 32.6%, 25.0%, P=0.020) and CPR (58.3%, 48.6% versus 30.4%, 25.0%, P=0.024) in long and short protocols were higher than rates of ultra-long and antagonist protocols, but no statistical differences were supported because of strict Bonferroni method (P=0.008).
CONCLUSION
In infertile women with adenomyosis, if a fresh embryo was planned for transfer, an ultra-long or long protocol might be beneficial. If antagonist and short protocols were used, whole embryos frozen followed by FET was recommended. In FET cycles, embryos derived from different protocols had no impact on pregnancy outcomes.
目的
评估不同卵巢刺激方案对患有子宫腺肌病的不孕妇女体外受精/胞浆内单精子注射（IVF/ICSI）结局的影响。
方法
我们对接受 IVF/ICSI 治疗的患有子宫腺肌病的不孕妇女进行了回顾性队列研究，包括 257 个新鲜胚胎移植（ET）周期和 305 个冷冻胚胎移植（FET）周期。在新鲜 ET 周期中，采用超长、长、短和拮抗剂方案。在 FET 周期中，患者接受长效 GnRH 激动剂（GnRHa）预处理或不预处理。主要结局是临床妊娠率（CPR），次要结局包括着床率（IR）、流产率（MR）和活产率（LBR）。
结果
在新鲜 ET 周期中，与超长和长方案相比，短方案的 IR（49.7%、52.1%比 28.2%，P=0.001）和 CPR（64.3%、57.4%比 35.6%，P=0.004）显著降低。同样，与超长和长方案相比，拮抗剂方案的 IR（49.7%、52.1%比 33.3%）和 CPR（57.4%、64.3%比 38.2%）也呈下降趋势，但由于 Bonferroni 方法的严格 P 调整，没有统计学意义（P=0.008）。与长方案相比，短方案的 LBR 明显降低（48.2%比 20.3%，P<0.001）。在 FET 周期中，无论胚胎来源如何，IR、CPR 和 LBR 均无统计学差异。对于接受新鲜 ET 的≥35 岁妇女，超长和长方案的 CPR 较高（52.1%、50.0%比 20.0%、27.5%，P=0.031），而拮抗剂和短方案较低。对于≥35 岁接受 FET 的妇女，与超长和拮抗剂方案相比，来自长和短方案的胚胎具有更高比例的长效 GnRHa 预处理（30.4%、30.00 比 63.9%、51.4%，P=0.009）。长和短方案的 IR（61.1%、48.6%比 32.6%、25.0%，P=0.020）和 CPR（58.3%、48.6%比 30.4%、25.0%，P=0.024）均高于超长和拮抗剂方案，但由于严格的 Bonferroni 方法（P=0.008），没有统计学意义。
结论
在患有子宫腺肌病的不孕妇女中，如果计划进行新鲜胚胎移植，超长或长方案可能有益。如果使用拮抗剂和短方案，则建议将所有胚胎冷冻，然后进行 FET。在 FET 周期中，来自不同方案的胚胎对妊娠结局没有影响。
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