Reproduction Center, The Third Affiliated Hospital of ZhengZhou University, Henan, China.
BMC Public Health. 2024 Jan 22;24(1):259. doi: 10.1186/s12889-024-17725-5.
Due to the high risk of complications in fresh transfer cycles among expected high ovarian response patients, most choose frozen-thawed embryo transfer (FET). There are currently few researches on whether the FET outcomes of expected high ovarian response patients with regular menstrual cycles are similar to those of normal ovarian response. Therefore, our objective was to explore and compare pregnancy outcomes and maternal and neonatal outcomes of natural FET cycles between patients with expected high ovarian response and normal ovarian response with regular menstrual cycles based on the antral follicle count (AFC).
This retrospective cohort study included 5082 women undergoing natural or small amount of HMG induced ovulation FET cycles at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 1, 2017, to March 31, 2021. The population was divided into expected high ovarian response group and normal ovarian response group based on the AFC, and the differences in patient characteristics, clinical outcomes and perinatal outcomes between the two groups were compared.
Regarding clinical outcomes, compared with the normal ovarian response group, patients in the expected high ovarian response group had a higher clinical pregnancy rate (57.34% vs. 48.50%) and live birth rate (48.12% vs. 38.97%). There was no difference in the early miscarriage rate or twin pregnancy rate between the groups. Multivariate logistic regression analysis suggested that the clinical pregnancy rate (adjusted OR 1.190) and live birth rate (adjusted OR 1.171) of the expected high ovarian response group were higher than those of the normal ovarian response group. In terms of maternal and infant outcomes, the incidence of very preterm delivery in the normal ovarian response group was higher than that in the expected high ovarian response group (0.86% vs. 0.16%, adjusted OR 0.131), Other maternal and infant outcomes were not significantly different. After grouping by age (< 30 y, 30-34 y, 35-39 y), there was no difference in the incidence of very preterm delivery among the age subgroups.
For patients with expected high ovarian response and regular menstrual cycles undergoing natural or small amount of HMG induced ovulation FET cycles, the clinical and perinatal outcomes are reassuring. For patients undergoing natural or small amount of HMG induced ovulation FET cycles, as age increases, perinatal care should be strengthened during pregnancy to reduce the incidence of very preterm delivery.
由于预期高卵巢反应患者在新鲜胚胎移植周期中存在较高的并发症风险，大多数人选择冷冻胚胎解冻移植（FET）。目前，关于月经周期正常的预期高卵巢反应患者的 FET 结局是否与正常卵巢反应患者相似的研究较少。因此，我们的目的是基于窦卵泡计数（AFC），探讨和比较预期高卵巢反应患者与月经周期正常的正常卵巢反应患者的自然 FET 周期的妊娠结局、母婴结局。
本回顾性队列研究纳入了 2017 年 1 月 1 日至 2021 年 3 月 31 日在郑州大学第三附属医院生殖中心接受自然或小剂量 HMG 诱导排卵 FET 周期的 5082 名妇女。根据 AFC 将人群分为预期高卵巢反应组和正常卵巢反应组，比较两组患者特征、临床结局和围产儿结局的差异。
在临床结局方面，与正常卵巢反应组相比，预期高卵巢反应组患者的临床妊娠率（57.34% vs. 48.50%）和活产率（48.12% vs. 38.97%）更高。两组早期流产率和双胞胎妊娠率无差异。多变量逻辑回归分析提示，预期高卵巢反应组的临床妊娠率（调整 OR 1.190）和活产率（调整 OR 1.171）均高于正常卵巢反应组。在母婴结局方面，正常卵巢反应组的极早产发生率高于预期高卵巢反应组（0.86% vs. 0.16%，调整 OR 0.131），其他母婴结局无显著差异。按年龄（<30 岁、30-34 岁、35-39 岁）分组后，年龄亚组的极早产发生率无差异。
对于月经周期正常、接受自然或小剂量 HMG 诱导排卵 FET 周期的预期高卵巢反应患者，临床和围产结局是令人放心的。对于接受自然或小剂量 HMG 诱导排卵 FET 周期的患者，随着年龄的增长，妊娠期间应加强围产期护理，以降低极早产的发生率。
