Balachandren Neerujah, Veeramani Meenakshi, Suriyakumar Sureka, Wiley Sarah, Mavrelos Dimitrios, Yasmin Ephia, Kastora Stavroula L
University College London, UCL EGA Institute for Women's Health, London, UK.
School of Medicine, Imperial College London, London, UK.
BJOG. 2025 Aug;132(9):1187-1201. doi: 10.1111/1471-0528.18172. Epub 2025 May 2.
Luteal support is a core success factor of frozen embryo transfers (FET). However, inconsistency across recommended protocols generates notable heterogeneity across reproductive outcomes.
To determine the most effective luteal support strategy (LPS) based on five key factors related to the effectiveness of FET cycles.
Twelve databases and two prospective registers were searched from inception to 1st January 2024. The study was prospectively registered under the PROSPERO database (CRD42024513549).
Randomised Controlled Trials (RCTs) and observational studies of women undergoing frozen embryo transfers were included.
Bayesian network meta-analysis (NMA) model presenting random effects, risk ratios (RRs) with 95% credibility intervals (CrIs) was employed. Primary outcomes included clinical pregnancy, live birth, and miscarriage. Secondary outcomes included biochemical pregnancy and multiple pregnancy events.
Fourteen studies, of which eight RCTs, comparing 12 interventions upon 4688 participants, were included. Overall, CiNeMa risk of bias was moderate, and network inconsistency per outcome was low. Thirteen studies reported on clinical pregnancy events with vaginal progesterone (VP) and a single or double dose of subcutaneous GnRH agonist (GnRHa), significantly improving clinical pregnancy, RR 1.86 [95% CrI 1.18, 2.93].
The addition of 0.1 mg subcutaneous GnRH agonist in a single (Day 3 post ET) or double (Day 3 and Day 6 post ET) schema upon a vaginal progesterone regimen till Week 12 appears to improve clinical pregnancy events in FET cycles.
黄体支持是冻融胚胎移植（FET）成功的核心因素。然而，推荐方案之间的不一致导致生殖结局存在显著异质性。
基于与FET周期有效性相关的五个关键因素，确定最有效的黄体支持策略（LPS）。
检索了从建库至2024年1月1日的12个数据库和2个前瞻性注册库。该研究已在PROSPERO数据库（CRD42024513549）中进行前瞻性注册。
纳入接受冻融胚胎移植女性的随机对照试验（RCT）和观察性研究。
采用呈现随机效应、风险比（RRs）及95%可信区间（CrIs）的贝叶斯网络荟萃分析（NMA）模型。主要结局包括临床妊娠、活产和流产。次要结局包括生化妊娠和多胎妊娠事件。
纳入了14项研究，其中8项RCT，共4688名参与者，比较了12种干预措施。总体而言，CiNeMa偏倚风险为中等，各结局的网络不一致性较低。13项研究报告了阴道用黄体酮（VP）联合单次或双次皮下注射促性腺激素释放激素激动剂（GnRHa）的临床妊娠事件，显著改善了临床妊娠，RR为1.86 [95% CrI 1.18, 2.93]。
在阴道黄体酮方案基础上，在胚胎移植后第3天单次或在胚胎移植后第3天和第6天两次添加0.1mg皮下GnRHa，直至第12周，似乎可改善FET周期的临床妊娠事件。
