Retrospective cohort study on preparation regimens for frozen embryo transfer.

Reproduction & Fertility Pub Date : 2021-11-23 eCollection Date: 2021-12-01 DOI:10.1530/RAF-21-0044
Monique Atkinson, Jenny Crittenden, Howard Smith, Cecilia Sjoblom
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引用次数: 2

Abstract

The objective of this study was to examine the pregnancy outcomes from frozen embryo transfer (FET) cycles using different endometrial preparation regimens, compared to ovulation induction with letrozole (letrozole OI). A retrospective cohort study was conducted at a fertility centre in Sydney, Australia, on 6060 FET cycles. The cycles were stratified into one of four ways to achieve endometrial preparation. These were either a natural, letrozole OI, OI with follicle-stimulating hormone (FSH OI) or a programmed cycle. The primary outcome was live birth rate (LBR) per embryo transfer. Secondary outcomes included clinical pregnancy and biochemical pregnancy rates, adverse events including miscarriage, ectopic pregnancy, stillbirth, neonatal death and multiple births. Ovarian stimulation parameters were also analysed including the time taken to reach the luteal phase and the number of blood or urine tests required for monitoring the cycle. The results of the study showed that the LBR following letrozole OI cycles was higher when compared to natural cycles (odds ratio (OR): 1.27 (1.07-1.49)) and programmed cycles (OR: 2.36 (1.67-3.34)). There was no significant difference between letrozole OI and FSH OI LBR (OR: 0.99 (0.76-1.28)). An improved LBR with letrozole OI compared to natural cycles was maintained when only women with a normal length cycle were considered (OR: 1.44 (1.10-1.89)). There was a significant reduction in miscarriage rates when letrozole OI was compared to programmed cycles (OR: 0.46 (0.26-0.83)). It was therefore concluded that the use of letrozole OI for endometrial preparation in an FET cycle may be associated with higher LBR and lower miscarriage rate, compared to using a programmed cycle.

Lay summary: Couples suffering from infertility frequently try to conceive following the transfer of an embryo which has been frozen during an in vitro fertilisation cycle. Embryos will only lead to a pregnancy if the woman's womb lining has particular characteristics that allow it to accept the embryo. Despite the thousands of frozen embryo transfer cycles carried out across the world, it is not known how best to prepare a woman's lining so it has these particular characteristics. This study looked at the pregnancy outcomes of 6060 cycles to compare four different ways to prepare a woman's womb lining. These included relying on a woman's natural menstrual cycle, or using an oral medication called letrozole, or injectable medicine called follicle-stimulating hormone, or oestrogen and progesterone hormonal medications. The comparison found that using letrozole before transfer of a frozen embryo may be associated with higher rates of a live birth for some women.

Abstract Image

冷冻胚胎移植准备方案的回顾性队列研究。
本研究的目的是检查使用不同子宫内膜准备方案的冷冻胚胎移植(FET)周期的妊娠结局,并与来曲唑(来曲唑OI)促排卵进行比较。在澳大利亚悉尼的一家生育中心进行了一项回顾性队列研究,共进行了6060个FET周期。周期被分层成四种方式之一,以实现子宫内膜准备。这些是天然的来曲唑成骨不全症、促卵泡激素成骨不全症或程序周期成骨不全症。主要终点是每个胚胎移植的活产率(LBR)。次要结局包括临床妊娠率和生化妊娠率,不良事件包括流产、异位妊娠、死胎、新生儿死亡和多胎。还分析了卵巢刺激参数,包括达到黄体期所需的时间和监测周期所需的血液或尿液检查次数。研究结果表明,与自然周期(比值比(OR): 1.27(1.07-1.49))和程序周期(OR: 2.36(1.67-3.34))相比,来曲唑成骨不全周期后的LBR更高。来曲唑OI与FSH OI的LBR差异无统计学意义(OR: 0.99(0.76-1.28))。当仅考虑正常周期长度的女性时,与自然周期相比,来曲唑成骨不全的LBR得到改善(OR: 1.44(1.10-1.89))。与计划周期相比,来曲唑成骨不全的流产率显著降低(OR: 0.46(0.26-0.83))。因此得出结论,在FET周期中使用来曲唑OI进行子宫内膜准备可能与使用程序化周期相比具有更高的LBR和更低的流产率。概要:患有不孕症的夫妇经常试图在体外受精周期中将冷冻的胚胎移植后怀孕。只有当女性的子宫内膜有特殊的特征可以接受胚胎时,胚胎才会导致怀孕。尽管世界各地进行了成千上万的冷冻胚胎移植周期,但人们并不知道如何最好地准备女性的子宫内膜,使其具有这些特殊的特征。这项研究观察了6060个周期的怀孕结果,比较了四种不同的方法来准备女性的子宫内膜。这些方法包括依靠女性的自然月经周期,或使用一种叫做来曲唑的口服药物,或注射一种叫做促卵泡激素的药物,或雌激素和黄体酮激素药物。比较发现,在冷冻胚胎移植前使用来曲唑可能与一些妇女更高的活产率有关。
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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