Cao Xu, Gao Caixia, Su Mingjiao, Zhang Dian, Zhao Fuyang, Li Wentao, Qu Pengfei, Shi Juanzi
Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, China.
Graduate Department, Xi'an Medical University, Xi'an, Shaanxi, China.
BMC Pregnancy Childbirth. 2025 Apr 14;25(1):449. doi: 10.1186/s12884-025-07535-x.
Few studies have analyzed the endometrial preparation protocols for frozen-thawed embryo transfer (FET) in patients at high risk of ovarian hyperstimulation syndrome (OHSS). This study aimed to investigate the optimal protocol for endometrial preparation in FET cycles for patients at high risk of OHSS.
This study included women who underwent assisted reproductive technology treatment between January 2021 and December 2022 at the Center for Assisted Reproductive Technology of Northwest Women's and Children's Hospital, China.Patients were categorized into three groups based on their endometrial preparation protocols: hormone replacement therapy (HRT), natural cycle (NC), and ovarian stimulation (OS). To balance covariates and sample sizes across the groups, propensity score matching was used. Multiple regression analyses were conducted on the matched datasets to assess the relationship between different protocols and pregnancy outcomes while controlling for confounding factors.
A total of 1783 patients were enrolled in this study, including 1431 in the HRT protocol group, 212 in the NC protocol group, and 140 in the OS protocol group. After propensity score matching and adjusting for potential confounders, multivariable regression analysis revealed that the NC group had a higher rate of live birth (adjusted OR: 1.50, 95% CI: 1.03-2.19) and biochemical pregnancy (adjusted OR: 1.57, 95% CI: 1.03-2.39), along with a lower cesarean delivery rate(adjusted OR: 0.44, 95% CI: 0.26-0.74) compared to the HRT group. Similarly, the OS group demonstrated a higher rate of live birth (adjusted OR: 2.53, 95% CI: 1.55-4.14), biochemical pregnancy (adjusted OR: 2.14, 95% CI: 1.22-3.75), and clinical pregnancy (adjusted OR: 1.86, 95% CI: 1.10-3.15), alongside a lower miscarriage rate (adjusted OR: 0.29, 95% CI: 0.12-0.71) compared to the HRT group.
For patients at high risk of ovarian hyperstimulation syndrome undergoing frozen-thawed embryo transfer, both the OS and NC protocols showed superior pregnancy outcomes compared to the HRT protocol for endometrial preparation.
很少有研究分析卵巢过度刺激综合征（OHSS）高危患者冻融胚胎移植（FET）的子宫内膜准备方案。本研究旨在探讨OHSS高危患者FET周期中子宫内膜准备的最佳方案。
本研究纳入了2021年1月至2022年12月在中国西北妇女儿童医院辅助生殖技术中心接受辅助生殖技术治疗的女性。根据子宫内膜准备方案，患者被分为三组：激素替代疗法（HRT）、自然周期（NC）和卵巢刺激（OS）。为了平衡各组的协变量和样本量，采用了倾向评分匹配法。对匹配后的数据集进行多元回归分析，以评估不同方案与妊娠结局之间的关系，同时控制混杂因素。
本研究共纳入1783例患者，其中HRT方案组1431例，NC方案组212例，OS方案组140例。经过倾向评分匹配并调整潜在混杂因素后，多变量回归分析显示，与HRT组相比，NC组的活产率（调整后的OR：1.50，95%CI：1.03-2.19）和生化妊娠率（调整后的OR：1.57，95%CI：1.03-2.39）更高，剖宫产率更低（调整后的OR：0.44，95%CI：0.26-0.74）。同样，与HRT组相比，OS组的活产率（调整后的OR：2.53，95%CI：1.55-4.14）、生化妊娠率（调整后的OR：2.14，95%CI：1.22-3.75）和临床妊娠率（调整后的OR：1.86，95%CI：1.10-3.15）更高，流产率更低（调整后的OR：0.29，95%CI：0.12-0.71）。
对于接受冻融胚胎移植的卵巢过度刺激综合征高危患者，在子宫内膜准备方面，OS和NC方案的妊娠结局均优于HRT方案。
