Reproductive Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Henan Key Laboratory of Reproduction and Genetics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Front Endocrinol (Lausanne). 2024 Jul 18;15:1416841. doi: 10.3389/fendo.2024.1416841. eCollection 2024.
To investigate potential differences in pregnancy outcomes among patients with regular menstruation who underwent frozen-thawed embryo transfer using natural cycle (NC) or hormone replacement therapy (HRT).
This study retrospectively analyzed 2672 patients with regular menstruation who underwent FET from November 2015 to June 2021 at the single reproductive medical center. A one-to-one match was performed applying a 0.02 caliper with propensity score matching. Independent factors influencing the live birth and clinical pregnancy rates were screened and developed in the nomogram by logistic regression analysis. The efficacy of live birth rate and clinical pregnancy rate prediction models was assessed with the area under the ROC curve, and the live birth rate prediction model was internally validated within the bootstrap method.
The NC protocol outperformed the HRT protocol in terms of clinical pregnancy and live birth rates. The stratified analysis revealed consistently higher live birth and clinical pregnancy rates with the NC protocol across different variable strata compared to the HRT protocol. However, compared to the HRT treatment, perinatal outcomes indicated that the NC protocol was related to a higher probability of gestational diabetes. Multifactorial logistic regression analysis demonstrated independent risk factors for live birth rate and clinical pregnancy rate. To predict the two rates, nomogram prediction models were constructed based on these influencing factors. The receiver operating characteristic curve demonstrated moderate predictive ability with an area under curve (AUC) of 0.646 and 0.656 respectively. The internal validation of the model for live birth rate yielded an average AUC of 0.646 implying the stability of the nomogram model.
This study highlighted that NC yielded higher live birth and clinical pregnancy rates in comparison to HRT in women with regular menstruation who achieved successful pregnancies through frozen-thawed embryo transfer. However, it might incur a higher risk of developing gestational diabetes.
探讨自然周期（NC）或激素替代疗法（HRT）在接受冻融胚胎移植的月经规律患者中对妊娠结局的潜在差异。
本研究回顾性分析了 2015 年 11 月至 2021 年 6 月在单中心生殖医学中心接受 FET 的 2672 例月经规律患者。采用 0.02 卡尺的倾向评分匹配进行一对一匹配。通过逻辑回归分析筛选和建立列线图中影响活产率和临床妊娠率的独立因素。采用 ROC 曲线下面积评估活产率和临床妊娠率预测模型的效能，并通过 bootstrap 方法对活产率预测模型进行内部验证。
NC 方案在临床妊娠率和活产率方面优于 HRT 方案。分层分析显示，与 HRT 方案相比，NC 方案在不同变量分层中均具有更高的活产率和临床妊娠率。然而，与 HRT 治疗相比，围产期结局表明 NC 方案与妊娠期糖尿病的发生概率较高相关。多因素逻辑回归分析显示活产率和临床妊娠率的独立危险因素。为了预测这两个比率，基于这些影响因素构建了列线图预测模型。ROC 曲线显示，预测活产率和临床妊娠率的曲线下面积（AUC）分别为 0.646 和 0.656，具有中等预测能力。活产率模型的内部验证平均 AUC 为 0.646，表明列线图模型的稳定性。
本研究表明，与 HRT 相比，NC 可提高月经规律并成功妊娠的冻融胚胎移植患者的活产率和临床妊娠率，但可能会增加发生妊娠期糖尿病的风险。
