Impact of endometrial preparation protocols on pregnancy outcomes in patients with unexplained recurrent implantation failure undergoing frozen embryo transfer.

IF 6.1 1区医学 Q1 ACOUSTICS

Ultrasound in Obstetrics & Gynecology Pub Date : 2025-03-27 DOI:10.1002/uog.29209

J Huang, Y Liao, L Xia, H Wu, Z Liu, J Lin, J Zhu, Y Zhao, Q Wu, H Chen, F von Versen-Höynck, L Tian

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Abstract

Objectives: To evaluate the impact of different endometrial preparation protocols on pregnancy outcomes in patients with unexplained recurrent implantation failure (uRIF) undergoing frozen embryo transfer (FET).

Methods: This retrospective cohort study reviewed 110 372 FET cycles from three fertility centers in China between January 2014 and July 2021. Among them, 4346 cycles were performed in patients with uRIF, including 557 who had the natural cycle (NC) protocol, 1310 who had the stimulated cycle (SC) protocol and 2479 who had the artificial cycle (AC) protocol. The primary outcome measure was live birth rate. For singleton live births, the main obstetric outcomes (hypertensive disorders of pregnancy, gestational diabetes mellitus, abnormal placentation and prelabor rupture of membranes) and neonatal outcomes (Cesarean delivery, preterm birth, post-term birth, low birth weight, macrosomia, small-for-gestational age, large-for-gestational age and major birth defect) were collected through standardized questionnaire interviews. Potential confounders were controlled by 1:1:1 propensity score matching and multivariable logistic regression analysis using prematched data.

Results: There were 397 cycles in each group after matching and all baseline characteristics were balanced with no significant differences between the groups. The live birth rate was comparable among the NC, SC and AC groups (29.5% vs 35.3% vs 33.0%, respectively; P = 0.21), as were the rates of clinical pregnancy, embryo implantation and miscarriage. The three groups differed significantly in Cesarean delivery rate (65.6% vs 71.1% vs 81.1%, respectively; P = 0.04), with post-hoc statistical significance identified between the NC and AC groups (P = 0.01). No significant associations were observed between endometrial preparation protocols and other pregnancy, obstetric and neonatal outcomes. The results after matching were in good agreement with the multivariable-adjusted outcomes before matching.

Conclusions: Our findings do not prioritize one specific endometrial preparation protocol over another for improving pregnancy rates among patients with uRIF; however, the increased risk of Cesarean delivery in the AC group necessitates careful consideration to optimize delivery outcomes. Nonetheless, given the overall high rate of Cesarean delivery in all three groups, further clarification is required on whether medical indication or personal preference influenced the decision on the mode of delivery. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

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子宫内膜准备方案对冷冻胚胎移植中原因不明的反复植入失败患者妊娠结局的影响。

目的：评价不同子宫内膜准备方案对不明原因复发性着床失败（uRIF）患者冷冻胚胎移植（FET）妊娠结局的影响。方法：这项回顾性队列研究回顾了2014年1月至2021年7月期间来自中国三个生育中心的110372个FET周期。其中，uRIF患者共进行4346个周期，其中自然周期（NC）方案557例，刺激周期（SC）方案1310例，人工周期（AC）方案2479例。主要结局指标为活产率。对于单胎活产，通过标准化问卷访谈收集主要产科结局（妊娠高血压疾病、妊娠期糖尿病、胎盘异常、产前破膜）和新生儿结局（剖宫产、早产、产后、低出生体重、巨大儿、小胎龄、大胎龄、重大出生缺陷）。潜在混杂因素采用1:1:1倾向评分匹配和多变量logistic回归分析控制。结果：配对后各组共397个周期，各项基线特征平衡，各组间无显著差异。NC组、SC组和AC组的活产率相当(分别为29.5%、35.3%和33.0%；P = 0.21)，临床妊娠率、胚胎着床率和流产率也有统计学意义。三组剖宫产率差异有统计学意义(分别为65.6%、71.1%、81.1%；P = 0.04)， NC组与AC组间差异有统计学意义（P = 0.01）。未观察到子宫内膜准备方案与其他妊娠、产科和新生儿结局之间的显著关联。匹配后的结果与匹配前的多变量调整结果吻合较好。结论：我们的研究结果并没有优先考虑一种特定的子宫内膜准备方案，而不是另一种方案，以提高uRIF患者的妊娠率；然而，AC组剖宫产的风险增加，需要仔细考虑以优化分娩结果。尽管如此，鉴于所有三组的剖宫产率总体较高，需要进一步澄清医疗指征或个人偏好是否影响了分娩方式的决定。©2025国际妇产科超声学会。

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

Ultrasound in Obstetrics & Gynecology 医学-妇产科学

CiteScore

12.30

自引率

14.10%

发文量

891

审稿时长

1 months

期刊介绍： Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.