冻融胚胎移植前的子宫内膜准备方法：一项比较真正自然周期、促排卵、激素替代治疗和促性腺激素释放激素激动剂预处理的回顾性队列研究。
Endometrial preparation methods prior to frozen embryo transfer: a retrospective cohort study comparing true natural cycle, ovulation induction, hormone replacement treatment and GnRHa pretreatment.
作者信息
Mei Jiaoqi, Liu Nana, Liu Yuxiang, Li Min
机构信息
Nanchang Reproductive Hospital, No. 597 Shuangmashi Road, Xinjian, Nanchang city, 330000, China.
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100000, China.
出版信息
BMC Pregnancy Childbirth. 2025 Mar 28;25(1):366. doi: 10.1186/s12884-025-07211-0.
PURPOSE
To compare pregnancy outcomes of four endometrial preparation methods prior to frozen embryo transfer (FET).
METHODS
A total of 3,030 programmed cycles were analyzed: 302 with natural cycle (NC), 131 with ovulation induction (OI), 1,078 with hormone replacement treatment (HRT), and 1,519 with GnRHa pretreatment (GnRHa + HRT). Primary outcomes investigated were positive human chorionic gonadotropin (hCG), chemical pregnancy, clinical pregnancy, abortion, and live birth. Additionally, the impact of age, body mass index (BMI), embryo number, high-quality embryo, and endometrial thickness on pregnancy outcomes were analyzed.
RESULTS
The positive hCG rates for NC, OI, HRT, and GnRHa + HRT groups were 63.4%, 62.6%, 68.3%, and 71.7%, respectively (P = 0.004). Clinical pregnancy rates were 50.4%, 54%, 57.5%, and 61.8%, respectively (P = 0.004). Live birth rates were 38.2%, 45%, 46.5%, and 50.9%, respectively (P = 0.007). No significant differences were found in abortion and chemical pregnancy rates among the four protocols. NC showed significantly higher positive hCG (p = 0.044), live birth (p = 0.005), and clinical pregnancy rates (p = 0.010) compared to other methods. Compared to HRT, GnRHa + HRT displayed significantly higher live birth (p = 0.027) and clinical pregnancy rates (p = 0.027). Multiple logistic regression showed that the number of embryos and high-quality embryos increased HCG positivity, clinical pregnancy, and live birth rates, while age reduced these rates. BMI increased the abortion rate, and endometrial thickness increased the live birth rate. Chemical pregnancy was unaffected by these factors.
CONCLUSION
NC offers improved outcomes compared to other methods. Additionally, specific factors such as embryo quality and embryo number significantly influence pregnancy outcomes.
CLINICAL TRIAL NUMBER
Not applicable.
目的
比较冻融胚胎移植（FET）前四种子宫内膜准备方法的妊娠结局。
方法
共分析了3030个程序化周期：自然周期（NC）302个，促排卵（OI）131个，激素替代治疗（HRT）1078个，促性腺激素释放激素激动剂预处理（GnRHa+HRT）1519个。研究的主要结局包括人绒毛膜促性腺激素（hCG）阳性、生化妊娠、临床妊娠、流产和活产。此外，分析了年龄、体重指数（BMI）、胚胎数量、优质胚胎和子宫内膜厚度对妊娠结局的影响。
结果
NC、OI、HRT和GnRHa+HRT组的hCG阳性率分别为63.4%、62.6%、68.3%和71.7%（P=0.004）。临床妊娠率分别为50.4%、54%、57.5%和61.8%（P=0.004）。活产率分别为38.2%、45%、46.5%和50.9%（P=0.007）。四种方案的流产率和生化妊娠率无显著差异。与其他方法相比，NC的hCG阳性率（p=0.044）、活产率（p=0.005）和临床妊娠率（p=0.010）显著更高。与HRT相比，GnRHa+HRT的活产率（p=0.027）和临床妊娠率（p=0.027）显著更高。多元逻辑回归显示，胚胎数量和优质胚胎数量增加了hCG阳性率、临床妊娠率和活产率，而年龄则降低了这些率。BMI增加了流产率，子宫内膜厚度增加了活产率。生化妊娠不受这些因素影响。
结论
与其他方法相比，NC的结局更佳。此外，胚胎质量和胚胎数量等特定因素显著影响妊娠结局。
临床试验编号
不适用。
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