The Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China.
Reprod Biol Endocrinol. 2024 Oct 14;22(1):124. doi: 10.1186/s12958-024-01294-8.
The impact of high body mass index (BMI) on embryo and pregnancy outcomes in women using the PPOS (progestin-primed ovarian stimulation) protocol during their first frozen embryo transfer (FET) cycles is not clear. This study is to investigate the impact of BMI on oocyte, embryo, and pregnancy outcomes in patients who underwent the PPOS protocol.
This retrospective study included the first FET cycle of 22,392 patients following the PPOS protocol. The impact of BMI on oocyte and pregnancy outcomes was assessed across different BMI groups, using direct acyclic graph to determine covariates, followed by the application of multiple linear and logistic regressions to further validate this influence.
The high BMI groups exhibited a higher number of oocytes; however, no significant differences were observed in good-quality embryos, clinical pregnancy rate, and implantation rate. Nevertheless, the high BMI groups demonstrated a significantly elevated miscarriage rate (9.9% vs. 12.2% vs. 15.7% vs. 18.3%, P < 0.001), particularly in late miscarriages, resulting in lower live birth rates (LBR, 41.1% vs. 40.2% vs. 37.3% vs. 36.2%, P = 0.001). These findings were further confirmed through multiple liner and logistic regression analyses. Additionally, several maternal factors showed significant associations with adjusted odds ratios for early miscarriage. However, women with a BMI ≥ 24 who underwent hormone replacement cycle or hMG late stimulation protocol for endometrial preparation experienced an increased risk of late miscarriage.
By utilizing the PPOS protocol, women with a high BMI exhibit comparable outcomes in terms of embryo and clinical pregnancies. However, an elevated BMI is associated with an increased risk of miscarriage, leading to a lower LBR. Adopting appropriate endometrial preparation protocols such as natural cycles and letrozole stimulation cycles may potentially offer benefits in reducing miscarriages.
在接受 PPOS（孕激素预刺激卵巢刺激）方案的患者中，高体重指数（BMI）对首次冷冻胚胎移植（FET）周期中胚胎和妊娠结局的影响尚不清楚。本研究旨在调查 PPOS 方案中 BMI 对卵子、胚胎和妊娠结局的影响。
本回顾性研究纳入了 22392 例接受 PPOS 方案的患者的首次 FET 周期。采用直接无环图确定协变量，评估不同 BMI 组的 BMI 对卵子和妊娠结局的影响，然后应用多元线性和逻辑回归进一步验证这种影响。
高 BMI 组的卵子数量较多，但优质胚胎数量、临床妊娠率和种植率无显著差异。然而，高 BMI 组的流产率明显升高（9.9%比 12.2%比 15.7%比 18.3%，P<0.001），尤其是晚期流产，导致活产率降低（41.1%比 40.2%比 37.3%比 36.2%，P=0.001）。多元线性和逻辑回归分析进一步证实了这一点。此外，一些母体因素与早期流产的调整后比值比有显著关联。然而，对于接受激素替代周期或 hMG 晚期刺激方案进行子宫内膜准备的 BMI≥24 的女性，晚期流产的风险增加。
通过使用 PPOS 方案，高 BMI 的女性在胚胎和临床妊娠方面的结局相当。然而，较高的 BMI 与流产风险增加相关，导致活产率降低。采用自然周期和来曲唑刺激周期等适当的子宫内膜准备方案可能有助于降低流产率。
