Gonadotropin Releasing Hormone Agonists Combined with Hormone Replacement Therapy Significantly Improves Reproductive Outcomes for Patients with Thin Endometrium and Intramural Fibroids in Frozen Embryo Transfer Cycles.

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL

Drug Design, Development and Therapy Pub Date : 2025-01-10 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S501809

Longlong Wei, Bing Tian, Shuna Wang, Siyue Xu, Cuilian Zhang

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Abstract

Background: Both intramural myomas and thin endometrium exert a detrimental influence on the outcomes of assisted reproductive technology (ART). The downregulation of gonadotropin releasing hormone agonists (GnRH-a) is regarded as an effective approach to reducing the size of intramural fibroids and enhancing endometrial receptivity. Consequently, we conducted this study to assess whether the GnRH-a combined with hormone replacement therapy (GnRH-a-HRT) can improve reproductive outcomes in frozen embryo transfer cycles for patients with a thin endometrium (≤7 mm) and intramural fibroids.

Methods: This retrospective cohort study encompassed 360 patients who underwent frozen embryo transfer following in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Patients were stratified into three groups based on the endometrial preparation protocol: the natural cycle (NC) group (n=96), the hormone replacement therapy (HRT) group (n=180), and the GnRH-a-HRT group (n=84). The live birth rate (LBR) was designated as the primary outcome, while clinical pregnancy rate (CPR), miscarriage rate, and ectopic pregnancy rate were classified as secondary outcomes.

Results: The LBR and CPR in the GnRH-a-HRT group were significantly higher than those in both the HRT group and the NC group (both P < 0.0001). A logistic regression model indicated that the LBR was significantly higher in the GnRH-a-HRT group compared to both the HRT group (odds ratio, 0.269; 95% confidence interval, 0.114-0.637; P = 0.003) and the NC group (odds ratio, 0.524; 95% confidence interval, 0.457-0.956; P = 0.023). Subgroup analyses based on the number and dimension of fibroids demonstrate the positive efficacy of the GnRH-a-HRT regimen.

Conclusion: Compared to NC and HRT protocol, improved reproductive outcomes were observed in the GnRH-a-HRT group. These findings provide valuable insights for exploration of the underlying mechanisms by which the GnRH-a-HRT protocol enhances reproductive outcomes in patients of thin endometrium with intramural fibroids.

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促性腺激素释放激素激动剂与激素替代疗法相结合可显著改善冷冻胚胎移植周期中子宫内膜薄和肌壁内肌瘤患者的生殖效果。

背景：子宫内膜内肌瘤和子宫内膜薄都会对辅助生殖技术（ART）的结果产生不利影响。下调促性腺激素释放激素激动剂（gonadotropin releasing hormone agonists, GnRH-a）被认为是减小子宫内膜肌瘤大小和增强子宫内膜容受性的有效途径。因此，我们进行了这项研究，以评估GnRH-a联合激素替代疗法（GnRH-a- hrt）是否可以改善子宫内膜薄（≤7 mm）和壁内肌瘤患者在冷冻胚胎移植周期中的生殖结局。方法：这项回顾性队列研究包括360例在体外受精/胞浆内单精子注射（IVF/ICSI）周期后接受冷冻胚胎移植的患者。根据子宫内膜准备方案将患者分为三组：自然周期（NC）组（n=96）、激素替代疗法（HRT）组（n=180）和GnRH-a-HRT组（n=84）。活产率（LBR）为主要结局，临床妊娠率（CPR）、流产率、异位妊娠率为次要结局。结果：GnRH-a-HRT组的LBR和CPR均显著高于HRT组和NC组（P < 0.0001）。logistic回归模型显示，GnRH-a-HRT组的LBR显著高于HRT组和HRT组(优势比0.269；95%置信区间为0.114-0.637；P = 0.003)和NC组(优势比，0.524；95%置信区间为0.457-0.956；P = 0.023)。基于肌瘤数量和尺寸的亚组分析显示了GnRH-a-HRT方案的积极疗效。结论：与NC和HRT方案相比，GnRH-a-HRT组的生殖结局有所改善。这些发现为探索GnRH-a-HRT方案提高薄子宫内膜合并壁内肌瘤患者生殖结局的潜在机制提供了有价值的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.