Timing of frozen-thawed embryo transfer after controlled ovarian stimulation in a non-elective freeze-all policy
Timing of frozen-thawed embryo transfer after controlled ovarian stimulation in a non-elective freeze-all policy
复制标题
非选择性全冷冻政策中受控卵巢刺激后冻融胚胎移植的时机
DOI：
10.21037/atm.2019.11.74
复制
发表时间：
2019-12-01
影响因子：
--
通讯作者：
Kuang, Yanping
中科院分区：
文献类型：
--
作者：
Huang, Jialyu;Lu, Xuefeng;Kuang, Yanping
背景资料：非选择性冻融政策在辅助生殖治疗中的应用越来越多，但控制性卵巢刺激（COS）后冻融胚胎移植（FET）的最佳时机仍有待研究。这项回顾性队列研究包括2，2013年1月至2016年12月，998名患者在第一个COS周期后使用非选择性冻结策略接受了首次FET护理学术医疗中心。将患者分为“立即”组和“延迟”组，“立即”组在取卵后第一个月经周期内进行FET，“延迟”组在COS后一个或多个月经周期后开始FET。（n=280; 9.3%），延迟组为91.3 +/- 19.4天（n= 2，718; 90.7%）。在此之前[1，246/2，718（45.8%）vs. 156/280（55.7%）; P=0.002]和倾向评分匹配（PSM）之后[123/280（43.9%）vs. 156/280（55.7%）; P=0.005]，延迟FET周期的活产率显著低于立即FET周期。当通过多变量logistic回归分析控制了一些混杂因素时，风险仍然显著，校正比值比（aOR）[95%置信区间（CI）]为0.69（0.53-0.90）和0.60（0.42-0.85）。结论：在COS后的第一个月经周期内立即进行FET，与非选择性冻结所有政策中将FET延迟到随后的周期相比，实现活产的机会更高。然而，这一结论仍需进一步的随机对照试验来证实。
Background: Non-elective freeze-all policy has been increasingly utilized in assisted reproductive treatment, but the optimal timing of frozen-thawed embryo transfer (FET) after controlled ovarian stimulation (COS) remains to be investigated.Methods: This retrospective cohort study included 2,998 patients who underwent their first FETs after the first COS cycles using the non-elective freeze-all strategy from Jan 2013 to Dec 2016 at a tertiary-care academic medical center. Patients were divided into the "immediate" group in which FET took place within the first menstrual cycle after oocyte retrieval, and the "delayed" group where FET started after one or more menstrual cycles following COS.Results: The mean interval between oocyte retrieval and FET was 33.3 +/- 5.8 days in the immediate group (n=280; 9.3%) and 91.3 +/- 19.4 days in the delayed group (n=2,718; 90.7%). Cycles with delayed FET had a significantly lower live birth rate than those with immediate FET before [1,246/2,718 (45.8%) vs. 156/280 (55.7%); P=0.002] and after propensity score matching (PSM) [123/280 (43.9%) vs. 156/280 (55.7%); P=0.005]. When controlling for a number of confounding factors by multivariable logistic regression analysis, the risk remained significant with the adjusted odds ratio (aOR) [95% confidence interval (CI)] of 0.69 (0.53-0.90) and 0.60 (0.42-0.85) before and after matching, respectively.Conclusions: Performing FET immediately within the first menstrual cycle following COS was associated with a higher chance to achieve live birth compared with delaying FET to subsequent cycles in a non-elective freeze-all policy. However, further randomized controlled trials are still needed to confirm this conclusion.