Xu Y, Yang R X, Li D Y, Zhang Y, Huang J D, Hu J J, Guan Y C, Sun L J
Reproductive Center of the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2023 Sep 12;103(34):2720-2726. doi: 10.3760/cma.j.cn112137-20221215-02653.
To study the effect of unexpected follicular development in artificial cycles on the clinical outcomes in frozen thawed embryo transfer based on propensity score matching(PSM). The retrospective cohort study analyzed the clinical data of 7 064 cycles (5 716 patients) of artificial cycle frozen-thawed embryo transfer (AC-FET) in the Reproduction Center of the Third Affiliated Hospital of Zhengzhou University from January 1, 2016 to December 31, 2020. The clinical data were divided into three groups according to the degree of follicular development in AC-FET: no follicular growth group (group A, 6 349 cycles), small follicular growth group (group B, 248 cycles), and large follicular growth group (group C, 467 cycles). Differences in clinical outcomes between the small follicle growth group (Group B) and the large follicle growth group (Group C) were compared with the no follicle growth group (Group A) after PSM and logistic regression to adjust for confounding factors at baseline. A binary logistic regression model was used to analyze the factors related to the unanticipated follicular development in AC-FET. Age [(,)] was [31.0 (28.0, 36.0)] years in Group A, [34.5 (30.0, 40.0)] years in Group B, and [36.0 (31.0, 41.0)] years in Group C. After adjusting for confounders, the differences between Groups A and B in clinical pregnancy rate (=0.169), live birth rate (=0.318), early abortion rate (=0.470), and miscarriage rate (=0.783) were not statistically significant. The differences in clinical pregnancy rate (=0.743), live birth rate (=0.486) and miscarriage rate (=0.080) between Groups A and C were not statistically significant, while early miscarriage rate (=0.034) differences were statistically significant. The age, BMI, basal AFC, AMH and starting dose of estrogen were correlates of the emergence of non-expected small follicles in Groups B and A. The adjusted () values (95%) were 1.03 (1.01-1.06), 0.93 (0.90-0.98), 0.97 (0.95-0.99), 0.96 (0.95-0.97), and 0.59 (0.45-0.77), all <0.05. Age, basal AFC, AMH and starting dose of estrogen were the associated factors of the appearance of non-expected large follicles in Groups C and A. The values (95%) were 1.03 (1.01-1.05), 0.93 (0.91-0.95), 0.96 (0.95-0.97), and 0.52 (0.42-0.64), all <0.05. In AC-FET, the clinical outcome of small follicular growth is similar to that of unfollicular growth; Compared with the growth without follicles, the growth and development of large follicles can reduce the early abortion rate; Patients with older age, less AFC, lower AMH, and lower initial dose of estrogen could be more likely to have unanticipated follicular development during endometrial preparation.
基于倾向评分匹配（PSM）研究人工周期中意外卵泡发育对冻融胚胎移植临床结局的影响。回顾性队列研究分析了郑州大学第三附属医院生殖中心2016年1月1日至2020年12月31日期间7064个周期（5716例患者）的人工周期冻融胚胎移植（AC-FET）临床数据。根据AC-FET中卵泡发育程度将临床数据分为三组：无卵泡生长组（A组，6349个周期）、小卵泡生长组（B组，248个周期）和大卵泡生长组（C组，467个周期）。在PSM和逻辑回归调整基线混杂因素后，比较小卵泡生长组（B组）和大卵泡生长组（C组）与无卵泡生长组（A组）的临床结局差异。采用二元逻辑回归模型分析AC-FET中意外卵泡发育的相关因素。A组年龄[（，）]为[31.0（28.0，36.0）]岁，B组为[34.5（30.0，40.0）]岁，C组为[36.0（31.0，41.0）]岁。调整混杂因素后，A组和B组在临床妊娠率（=0.169）、活产率（=0.318）、早期流产率（=0.470）和流产率（=0.783）方面的差异无统计学意义。A组和C组在临床妊娠率（=0.743）、活产率（=0.486）和流产率（=0.080）方面的差异无统计学意义，而早期流产率（=0.034）差异有统计学意义。年龄、BMI、基础AFC、AMH和雌激素起始剂量是B组和A组中意外小卵泡出现的相关因素。调整后的（）值（95%）分别为1.03（1.01-1.06）、0.93（0.90-0.98）、0.97（0.95-0.99）、0.96（0.95-0.97）和0.59（0.45-0.77），均<0.05。年龄、基础AFC、AMH和雌激素起始剂量是C组和A组中意外大卵泡出现的相关因素。值（95%）分别为1.03（1.01-1.05）、0.93（0.91-0.95）、0.96（0.95-0.97）和0.52（0.42-0.64），均<0.05。在AC-FET中，小卵泡生长的临床结局与无卵泡生长相似；与无卵泡生长相比，大卵泡的生长发育可降低早期流产率；年龄较大、AFC较少、AMH较低和雌激素初始剂量较低的患者在子宫内膜准备期间更有可能出现意外卵泡发育。
