Department of Obstetrics and Gynaecology, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Monash Womens, Monash Health, Clayton, Victoria, Australia.
J Assist Reprod Genet. 2024 Jun;41(6):1549-1555. doi: 10.1007/s10815-024-03103-y. Epub 2024 Apr 3.
To examine the interaction between serum progesterone concentration on the trigger day and choice of freeze-all and fresh transfer strategies on live birth in an unselected population as well as in patients over 35 years old.
We performed a retrospective cohort study of 26,661 patients commencing their first IVF cycle in a large fertility centre between 2015 and 2019, including 4687 patients over 35 years old. We performed a multivariable fractional polynomial interaction analysis within a logistic regression model to investigate the interaction between serum progesterone concentration and the choice of freeze-all or fresh transfer strategy following the first transfer.
15,539 patients underwent a fresh embryo transfer and 11,122 underwent a freeze-all strategy in their first IVF cycle. The freeze-all group had a higher live birth rate compared to the fresh group (43.9% vs 40.3%). After adjusting for confounding factors, there was a positive interaction between serum progesterone concentrations and the choice of a freeze-all versus fresh embryo transfer on live birth (p for interaction 0.0001), with a larger magnitude of effect when progesterone concentration was higher. Such an interaction was also observed in patients over 35 years old (p for interaction 0.01), but the treatment effect curve over progesterone concentrations was almost flat.
In an unselected population, frozen transfer is associated with greater chances of live birth, especially in patients with higher serum progesterone concentration. In patients over 35 years old, the benefit of a freeze-all policy appears small across all serum progesterone concentrations.
在未选择人群以及年龄超过 35 岁的患者中，研究触发日血清孕酮浓度与冷冻保存和新鲜胚胎移植策略选择之间的相互作用，以评估其对活产率的影响。
我们对 2015 年至 2019 年期间在一家大型生育中心进行首次体外受精（IVF）周期的 26661 名患者进行了回顾性队列研究，其中包括 4687 名年龄超过 35 岁的患者。我们在逻辑回归模型中进行了多变量分数多项式交互分析，以调查首次移植后血清孕酮浓度与冷冻保存或新鲜胚胎移植策略选择之间的交互作用。
15539 名患者进行了新鲜胚胎移植，11122 名患者进行了冷冻保存策略。与新鲜胚胎组相比，冷冻保存组的活产率更高（43.9% vs. 40.3%）。调整混杂因素后，血清孕酮浓度与冷冻保存与新鲜胚胎移植选择之间存在活产率的正交互作用（交互作用 p 值<0.0001），且孕酮浓度越高，这种交互作用的程度越大。这种交互作用在年龄超过 35 岁的患者中也存在（交互作用 p 值=0.01），但孕酮浓度的治疗效果曲线几乎是平坦的。
在未选择的人群中，冷冻保存与更高的活产率相关，尤其是在血清孕酮浓度较高的患者中。在年龄超过 35 岁的患者中，无论血清孕酮浓度如何，冷冻保存策略的获益似乎都较小。
