在冻融胚胎移植中使用催产素受体拮抗剂改善腺肌病患者的早期流产率：一项倾向评分匹配研究。

Improvement of early miscarriage rates in women with adenomyosis via oxytocin receptor antagonist during frozen embryo transfer-a propensity score-matched study.

机构信息

Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung City, Zuoying Dist, 81362, Taiwan.

Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan.

出版信息

Reprod Biol Endocrinol. 2024 Jul 12;22(1):79. doi: 10.1186/s12958-024-01255-1.

DOI:10.1186/s12958-024-01255-1

PMID:38997744

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11241821/

Abstract

BACKGROUND

Dysfunctional uterine peristalsis seems to play a pivotal role in hindering embryo implantation among women diagnosed with adenomyosis. This research aims to investigate whether administering an oxytocin receptor antagonist during a frozen embryo transfer (FET) cycle using a hormone replacement therapy (HRT) protocol can enhance in vitro fertilization (IVF) outcomes for infertile women affected by adenomyosis.

METHODS

Between January 2018 and June 2022, our reproductive center conducted IVF-FET HRT cycles for infertile women diagnosed with adenomyosis. Propensity score matching was employed to select matched subjects between the two groups in a 1:1 ratio. Following this, 168 women received an oxytocin receptor antagonist during FET, constituting the study group, while the matched 168 women underwent FET without this antagonist, forming the control group. We conducted comparative analyses of baseline and cycle characteristics between the two groups, along with additional subgroup analyses.

RESULTS

The study group exhibited notably lower rates of early miscarriage compared to the control group, although there were no significant differences in clinical pregnancy rates, ongoing pregnancy rates, and live birth rates between the two groups. Multivariate analysis revealed a negative correlation between the use of oxytocin receptor antagonists and early miscarriage rates in women with adenomyosis. Subgroup analyses, categorized by age, infertility types, and embryo transfer day, showed a substantial decrease in early miscarriage rates within specific subgroups: women aged ≥ 37 years, those with secondary infertility, and individuals undergoing day 3 embryo transfers in the study group compared to the control group. Furthermore, subgroup analysis based on adenomyosis types indicated significantly higher clinical pregnancy rates, ongoing pregnancy rates and live birth rates in the study group compared to the control group among women with diffuse adenomyosis.

CONCLUSIONS

Administering an oxytocin receptor antagonist during FET may reduce the early miscarriage rates in women with adenomyosis.

摘要

背景

子宫蠕动功能障碍似乎在阻碍被诊断为子宫腺肌病的女性胚胎着床方面起着关键作用。本研究旨在探讨在接受激素替代疗法（HRT）方案的冷冻胚胎移植（FET）周期中使用催产素受体拮抗剂是否可以提高受腺肌病影响的不孕妇女的体外受精（IVF）结局。

方法

我们的生殖中心于 2018 年 1 月至 2022 年 6 月对被诊断为子宫腺肌病的不孕妇女进行了 IVF-FET HRT 周期。采用倾向评分匹配以 1:1 的比例在两组之间选择匹配的受试者。之后，168 名妇女在 FET 中接受了催产素受体拮抗剂，构成了研究组，而 168 名匹配的妇女在没有这种拮抗剂的情况下进行了 FET，形成了对照组。我们对两组的基线和周期特征进行了比较分析，并进行了额外的亚组分析。

结果

研究组的早期流产率明显低于对照组，尽管两组的临床妊娠率、持续妊娠率和活产率无显著差异。多变量分析显示，在患有子宫腺肌病的妇女中，使用催产素受体拮抗剂与早期流产率呈负相关。根据年龄、不孕类型和胚胎移植日进行的亚组分析显示，在特定亚组中，早期流产率显著降低：研究组中年龄≥37 岁的妇女、继发性不孕的妇女和进行第 3 天胚胎移植的妇女，与对照组相比。此外，基于腺肌病类型的亚组分析显示，弥漫性腺肌病妇女中研究组的临床妊娠率、持续妊娠率和活产率显著高于对照组。