Sachs-Guedj Noémie, Coroleu Buenaventura, Pascual María Ángela, Rodríguez Ignacio, Polyzos Nikolaos P
Department of Obstetrics, Gynecology and Reproduction, Dexeus University Hospital, 08028 Barcelona, Spain.
Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain.
J Clin Med. 2023 Sep 19;12(18):6058. doi: 10.3390/jcm12186058.
(1) Background: The presence of adenomyosis among pregnant patients has been associated with a higher incidence of miscarriage and pregnancy complications. Although the role of adenomyosis in women undergoing in vitro fertilization (IVF) was investigated in several studies and demonstrated a potentially detrimental effect on live birth rates following IVF, most of them were small studies in which the adenomyosis diagnosis was not confirmed based on solid ultrasonographic criteria. (2) Methods: 3503 patients undergoing their first blastocyst frozen transfer through a hormonal replacement (HRT) FET cycle. Among them, 140 women had a confirmed diagnosis of adenomyosis based on the MUSA criteria. (3) Results: Adenomyosis patients were more likely to proceed with deferred FET compared with no-adenomyosis women ( = 0.002) and were significantly more likely to be treated with GnRH agonist pre-treatment (2 months) ( < 0.001). The presence of adenomyosis significantly decreased the clinical pregnancy rates (aOR 0.62, 95% CI: 0.39-0.98, = 0.040) and live birth rates (aOR 0.46, 95% CI: 0.27-0.75, = 0.003) and significantly increased the miscarriage rates (aOR 2.13, 95% CI: 0.98-4.37, = 0.045). Multivariable logistic regression adjusting for age, autologous or donor oocytes, PGT-A, deferred FET, serum progesterone levels the day before FET, GnRH agonist pre-treatment, number of embryos transferred, and adenomyosis demonstrated that the use of the GnRH agonist protocol did not decrease or increase the miscarriage rate, clinical pregnancy rate, or live birth rate. (4) Conclusions: The presence of adenomyosis had a significant negative impact on the clinical outcomes of patients undergoing FET and was associated with higher miscarriage, lower clinical pregnancy, and live birth rates. GnRH agonist pre-treatment does not appear to improve clinical outcomes.
(1) 背景：妊娠患者中子宫腺肌病的存在与流产和妊娠并发症的较高发生率相关。尽管多项研究对子宫腺肌病在接受体外受精（IVF）的女性中的作用进行了调查，并证明其对IVF后的活产率有潜在不利影响，但其中大多数是小型研究，子宫腺肌病的诊断并非基于可靠的超声标准得到证实。(2) 方法：3503例患者通过激素替代（HRT）FET周期进行首次囊胚冷冻移植。其中，140名女性根据MUSA标准被确诊为子宫腺肌病。(3) 结果：与无子宫腺肌病的女性相比，子宫腺肌病患者更有可能进行延期FET（P = 0.002），且接受GnRH激动剂预处理（2个月）的可能性显著更高（P < 0.001）。子宫腺肌病的存在显著降低了临床妊娠率（调整后比值比[aOR] 0.62，95%可信区间[CI]：0.39 - 0.98，P = 0.040）和活产率（aOR 0.46，95% CI：0.27 - 0.75，P = 0.003），并显著增加了流产率（aOR 2.13，95% CI：0.98 - 4.37，P = 0.045）。对年龄、自体或供体卵母细胞、植入前遗传学检测（PGT - A）、延期FET、FET前一天的血清孕酮水平、GnRH激动剂预处理、移植胚胎数量和子宫腺肌病进行多变量逻辑回归分析表明，使用GnRH激动剂方案并未降低或增加流产率、临床妊娠率或活产率。(4) 结论：子宫腺肌病的存在对接受FET的患者的临床结局有显著负面影响，并与较高的流产率、较低的临床妊娠率和活产率相关。GnRH激动剂预处理似乎并不能改善临床结局。
