Comparison of the maternal-fetal outcomes between the fresh embryo transfer and different endometrial preparation protocols for the frozen-thawed embryo transfer
10.3760/cma.j.cn101441-20210908-00402
- VernacularTitle:新鲜周期与不同内膜准备方案冻融胚胎移植周期母胎结局比较
- Author:
Wei GUO
1
;
Linlin WANG
1
;
Lixue CHEN
1
;
Tian TIAN
1
;
Yuanyuan WANG
1
;
Rui YANG
1
;
Ping LIU
1
;
Rong LI
1
;
Jie QIAO
1
Author Information
1. 北京大学第三医院妇产科生殖医学中心，北京 100191
- Publication Type:Journal Article
- Keywords:
Pregnancy complications;
Reproductive technology, assisted;
Maternal-fetal outcome;
Embryo transfer strategy
- From:
Chinese Journal of Reproduction and Contraception
2022;42(12):1241-1249
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To perform a comparative study of obstetric outcomes in fresh cycles and different endometrial preparation protocols in frozen-thawed embryo transfer (FET) cycles, in order to guide the follow-up clinical consulting service and applications.Methods:This retrospective cohort study was conducted in a cohort of 22 395 consecutive cases with live birth following successful in vitro fertilization and embryo transfer (IVF-ET)/FET performed at the Center for Reproductive Medicine, Department of Obstetrics and Gynecology of Peking University Third Hospital from January 2014 to June 2017. According to the method of embryo transfer cycles, they were divided into fresh cycle group, natural cycle (NC)-FET cycle group and hormone replacement therapy (HRT)-FET cycle group. The primary outcome indicators of the study were the maternal and fetal outcomes in obstetrics, and the secondary outcome indicators were the basic data such as reproductive-related clinical data and laboratory-related indicators in each group. Logistic regression was used to analyze the influence of cycles on the obstetrical outcomes. Results:Among the 22 395 cycles, there were 12 118 cycles in fresh group, 6648 cycles in NC-FET group, and 3629 cycles in HRT-FET group. Among the basic characteristics: 1) There was a statistical difference in infertility duration among the three groups ( P=0.007), and differences were also found in female age, female body mass index (BMI), male age, the proportion of infertile type, and mean endometrial thickness on human chorionic gonadotropin (hCG)/conversion day among the three groups (all P<0.001); the mean endometrial thickness among the women with the fresh cycles [(11.13±1.63) mm] was the thickest, followed by the NC-FET cycles [(10.61±1.74) mm] and the lowest in the HRT-FET cycles [(9.77±1.58) mm]. 2) The proportion of blastocysts transferred increased in the FET cycles [NC-FET cycles 54.8% (3646/6648), HRT-FET cycles 52.4% (1901/3629)] compared with fresh cycles [3.8% (461/12 118), P<0.001]. 3) The incidence of monozygotic twins after blastocyst transfer increased ( P<0.001). Maternal-fetal outcomes: 1) The difference was observed in the live birth rate among the three groups ( P>0.001). 2) There was a statistical difference in the gestational age of delivery among the three groups [fresh cycles (38.39±2.08) weeks, NC-FET cycles (38.69±1.87) weeks, HRT-FET cycles (38.40±2.31) weeks, P<0.001], the full-term pregnancy induction rate (greater than 40 weeks) [19.8% (1315/6648), 19.0% (690/3629)], the newborn weight [(3 168.05±607.90) g, (3 124.70±683.53) g] and the macrosomia rate [7.8% (521/6648), 8.5% (309/3629)] were higher in the NC-FET and HRT-FET cycles than those in fresh cycles [16.6% (2017/12 118), (3 007.61±627.60) g, 6.6% (804/12 118), all P<0.001]. 3) In HRT-FET cycles, the premature birth rate [16.9% (615/3629)], the cesarean section rate [75.7% (2748/3629)], and the low birth weight rate [12.1% (438/3629)] were significantly higher than those in NC-FET cycles [12.6% (838/6648), 69.4% (4611/6648), 9.6% (637/6648), all P<0.001]. 4) The incidence of gestational hypertension, the incidence of gestational diabetes and the incidence of premature rupture of membranes in HRT-FET cycles [5.0% (182/3629), 6.7% (244/3629), 3.4% (124/3629)] were significantly different from those in NC cycles [1.6% (198/12 118), 2.4% (198/12 118), 2.9% (351/12 118)] and NC-FET cycles [2.0% (134/6648), 6.2% (410/6648), 2.1% (140/6648), P<0.001]. 5) The incidence of placental abnormalities/postpartum hemorrhage also increased significantly in HRT-FET cycles [1.0% (37/3629)] compared with NC-FET cycles [0.6% (41/6648), P=0.042]. Conclusion:The application of FET in assisted reproductive technology is safe and becoming widespread. Fetal complications are less than the fresh cycles, but maternal obstetric complications increase during HRT-FET cycles. Therefore, in different protocols of FET, when NC-FET is available, it is recommended as the first choice.
