在接受受精的子宫内膜增生伴或不伴非典型性的不孕患者中，妊娠结局：早卵泡期长方案优于中黄体期长方案。

Pregnancy outcomes in infertile patients with endometrial hyperplasia with or without atypia undergoing fertilization: the early-follicular long protocol is superior to midluteal long protocol.

机构信息

Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

出版信息

Front Endocrinol (Lausanne). 2024 Feb 19;15:1314432. doi: 10.3389/fendo.2024.1314432. eCollection 2024.

DOI:10.3389/fendo.2024.1314432

PMID:38449849

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10916507/

Abstract

BACKGROUND

Although fertilization (IVF) in infertile patients with endometrial hyperplasia is common after drug treatment, the pregnancy outcomes are often unsatisfactory. Till date, no studies have reported the outcome of patients with endometrial hyperplasia treated using early-follicular long (EL) protocol and midluteal long (ML) protocol.

OBJECTIVE

To evaluate the pregnancy outcomes and disease prognosis of patients with endometrial hyperplasia with or without atypia undergoing IVF treatment with EL protocol or ML protocol.

METHODS

This was a retrospective study in university-affiliated reproductive medical center. A total of 138 patients with endometrial hyperplasia undergoing IVF treatment were included to compare the pregnancy outcomes and disease prognosis between EL and ML protocols. We further matched 276 patients with normal endometrium to compare the pregnancy outcomes between patients with endometrial hyperplasia and patients with normal endometrium under different controlled ovarian stimulation (COS) protocol.

RESULTS

In patients with endometrial hyperplasia, the clinical pregnancy rate (CPR) and live birth rate (LBR) were significantly higher in EL protocol than in ML protocol (61.8% vs. 43.5%, P=0.032; 50.0% vs. 30.6%, P= 0.022). In the ML protocol, patients with endometrial hyperplasia had significantly lower CPR and LBR than those with normal endometrium (43.5% vs. 59.7%, P=0.037; 30.6% vs. 49.2%, P=0.016). While in the EL protocol, they achieved similar CPR and LBR as patients with normal endometrium (61.8% vs. 69.7%, P=0.232; 50.0% vs. 59.9%, P=0.156). In patients with endometrial hyperplasia, COS protocol was an independent factor affecting clinical pregnancy (adjusted odds ratio [OR] 2.479; 95% confidence interval [CI] 1.154-5.327) and live birth (adjusted OR 2.730; 95% CI 1.249-5.966). After 1-10 years of follow-up, no significant difference was found in the recurrence rate of endometrial lesions between both treatment groups.

CONCLUSIONS

For patients with endometrial hyperplasia undergoing IVF treatment, the EL protocol is superior to ML protocol, and in the EL protocol, they can achieve similar pregnancy outcomes as patients with normal endometrium.

摘要

背景

虽然对于药物治疗后子宫内膜增生的不孕患者，经受精（IVF）治疗后妊娠结局通常并不理想，但目前尚无研究报道子宫内膜增生患者分别接受早卵泡期长方案（EL 方案）和中晚卵泡期长方案（ML 方案）治疗后的结局。

目的

评估接受 EL 方案或 ML 方案治疗的子宫内膜增生伴或不伴非典型增生患者的妊娠结局和疾病预后。

方法

这是一项在大学附属医院生殖医学中心进行的回顾性研究。共纳入 138 例接受 IVF 治疗的子宫内膜增生患者，比较 EL 方案和 ML 方案对妊娠结局和疾病预后的影响。我们进一步匹配了 276 例正常子宫内膜患者，比较了不同控制性卵巢刺激（COS）方案下子宫内膜增生患者与正常子宫内膜患者的妊娠结局。

结果

在子宫内膜增生患者中，EL 方案的临床妊娠率（CPR）和活产率（LBR）明显高于 ML 方案（61.8%比 43.5%，P=0.032；50.0%比 30.6%，P=0.022）。在 ML 方案中，子宫内膜增生患者的 CPR 和 LBR 明显低于正常子宫内膜患者（43.5%比 59.7%，P=0.037；30.6%比 49.2%，P=0.016）。而在 EL 方案中，子宫内膜增生患者的 CPR 和 LBR 与正常子宫内膜患者相似（61.8%比 69.7%，P=0.232；50.0%比 59.9%，P=0.156）。在子宫内膜增生患者中，COS 方案是影响临床妊娠（调整优势比[OR]2.479；95%置信区间[CI]1.154-5.327）和活产（调整 OR 2.730；95%CI 1.249-5.966）的独立因素。在 1-10 年的随访中，两组患者子宫内膜病变的复发率无显著差异。