Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Endocrinol (Lausanne). 2023 Sep 5;14:1238887. doi: 10.3389/fendo.2023.1238887. eCollection 2023.
The utilization of frozen-thawed embryo transfer (FET) cycles has been linked to heightened risks of adverse perinatal outcomes. However, the potential association between adverse perinatal outcomes and distinct endometrial preparation regimens remains unclear. Therefore, we aim to investigate the maternal and neonatal outcomes after hormone replacement treatment (HRT) cycles, natural cycles (NC) and HRT cycles with pretreatment using GnRHa (HRT + GnRHa) for ovulatory women undergoing FET cycles.
A large sample retrospective cohort study was carried out from 2016 to 2020. The data included a total of 5316 women who had singleton deliveries undergoing FET cycles and which were divided into three groups based on different endometrial preparation protocols: 4399 patients in HRT groups, 621 in GnRHa+HRT groups, 296 in NC groups. The outcomes consisted of maternal outcomes (cesarean section, hypertensive disorders of pregnancy (HDP), placenta previa, gestational diabetes mellitus (GDM));and neonatal outcomes (preterm birth, newborn birthweight, low birthweight, small for gestational age (SGA), macrosomia, large for gestational age (LGA), fetal malformation).
After adjusting for a series of confounding variables, we found an increased risk of HDP (aOR=3.362; 95%CI, 1.059-10.675) and cesarean section (aOR=1.838; 95%CI, 1.333-2.535) in HRT cycles compared with NC, especially for ovulatory women under 35 years old. However, in all three groups, newborn birth weight was not significantly different. Meanwhile, perinatal outcomes did not differ significantly in terms of perinatal outcomes in HRT +GnRHa cycles compared with HRT cycles solely.
During FET cycles, singletons from HRT were related to higher risks of HDP and cesarean section, particularly for young women. GnRHa pretreatment didn't bring any benefit to perinatal outcomes compared with HRT cycles alone. Therefore, the natural cycle may be a more appropriate and safer option for young ovulatory women.
冷冻胚胎解冻移植（FET）周期的应用与围产儿不良结局的风险增加有关。然而，不同的子宫内膜准备方案与不良围产儿结局之间的潜在关联尚不清楚。因此，我们旨在研究接受 FET 周期的排卵女性在接受激素替代治疗（HRT）周期、自然周期（NC）和 HRT 周期加 GnRHa 预处理（HRT+GnRHa）后的母婴结局。
这是一项从 2016 年到 2020 年进行的大型回顾性队列研究。数据包括 5316 名接受 FET 周期的单胎分娩女性，根据不同的子宫内膜准备方案分为三组：4399 例 HRT 组、621 例 GnRHa+HRT 组、296 例 NC 组。结局包括母婴结局（剖宫产、妊娠高血压疾病（HDP）、前置胎盘、妊娠期糖尿病（GDM））和新生儿结局（早产、新生儿出生体重、低出生体重、小于胎龄儿（SGA）、巨大儿、大于胎龄儿（LGA）、胎儿畸形）。
在调整了一系列混杂变量后，我们发现与 NC 相比，HRT 周期中 HDP（aOR=3.362；95%CI，1.059-10.675）和剖宫产（aOR=1.838；95%CI，1.333-2.535）的风险增加，尤其是对于 35 岁以下的排卵女性。然而，在所有三组中，新生儿出生体重均无显著差异。同时，与单纯 HRT 周期相比，HRT+GnRHa 周期的围产儿结局在围产儿结局方面无显著差异。
在 FET 周期中，HRT 周期的单胎与 HDP 和剖宫产的风险增加有关，尤其是对于年轻女性。与单纯 HRT 周期相比，GnRHa 预处理并没有给围产儿结局带来任何益处。因此，对于年轻的排卵女性来说，自然周期可能是一种更合适和更安全的选择。
