Effect of GnRH-a down-regulation combined with artificial cycle protocol on pregnancy outcomes in patients with unexplained repeated implantation failure
10.3760/cma.j.cn101441-20221114-00505
- VernacularTitle:GnRH-a降调节人工周期方案对不明原因反复种植失败患者妊娠结局的影响
- Author:
Caixia YUAN
1
;
Kailun HU
;
Rong LI
Author Information
1. 山西省人民医院生殖医学科，太原 030012
- Publication Type:Journal Article
- Keywords:
Pregnancy outcome;
Repeated implantation failure;
Frozen-thawed embryo transfer;
GnRH-a down-regulation;
Artificial cycle
- From:
Chinese Journal of Reproduction and Contraception
2023;43(12):1216-1221
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of gonadotropin-releasing hormone agonist (GnRH-a) down-regulation combined with artificial cycle (AC) protocol on pregnancy outcomes in patients with unexplained repeated implantation failure (RIF).Methods:The clinical data of 1 285 frozen-thawed cycles of unexplained RIF patients who underwent frozen-thawed embryo transfer from January 2018 to December 2019 in the Reproductive Medical Center of Peking University Third Hospital were retrospectively analyzed. They were divided into two groups according to different endometrial preparation protocols: GnRH-a down-regulation combined with AC protocol group (named GnRH-a+AC group, 411 cycles) and AC group (874 cycles). The general clinical data, cycle characteristics and clinical outcomes between the two groups were compared. Multiple logistic regression analysis was used to analyze the influencing factors of clinical pregnancy and live birth.Results:There was no significant difference in the general data between the two groups ( P>0.05). The endometrial thickness of GnRH-a+AC group [(10.26±1.73) mm] was thicker than that of AC group [(9.66±1.54) mm], and the difference was statistically significant ( P=0.002). The clinical pregnancy rate [42.58% (175/411)] and the embryo implantation rate [32.52% (200/615)] of GnRH-a+AC group were higher than those of AC group [35.59% (311/874), P=0.016; 27.20% (346/1 271), P=0.017], and the differences were statistically significant. The live birth rate of GnRH-a+AC group [33.57% (138/411)] showed an increasing tendency, but there was no significant difference compared with AC group [28.73% (251/874), P>0.05]. The multivariate logistic regression analysis showed that the clinical pregnancy rate was negatively correlated with age and body mass index (BMI; OR=0.953, 95% CI: 0.924-0.982; OR=0.959, 95% CI: 0.926-0.994), and positively correlated with GnRH-a protocol ( OR=1.329, 95% CI: 1.039-1.699); the live birth rate was only negatively correlated with age and BMI ( OR=0.947, 95% CI: 0.917-0.977; OR=0.963, 95% CI: 0.927-0.998) and GnRH-a protocol was not an influencing factor ( P>0.05). Endometrial thickness ≥7 mm was not the influencing factor of clinical pregnancy rate and live birth rate (all P>0.05). Conclusion:For RIF patients, GnRH-a down-regulation combined with AC protocol can significantly increase endometrial thickness, improve endometrial receptivity and clinical pregnancy rate, but there is no statistical significance in the live birth rate, which still needs to be further studied in large scale.
