生殖医学杂志2023，Vol.32Issue(12)：1798-1805,8.DOI:10.3969/j.issn.1004-3845.2023.12.006
GnRH-a预处理和BMI对PCOS患者首次冻融胚胎移植周期妊娠结局的影响
Effects of GnRH-agonist pretreatment and BMI on pregnancy outcomes of first frozen-thawed embryo transfer cycle in PCOS patients
摘要
Abstract
Objective:To investigate the effects of long-acting GnRH agonist(GnRH-a)pretreatment and body mass index(BMI)on the pregnancy outcomes of the first frozen-thawed embryo transfer(FET)cycle in patients with polycystic ovary syndrome(PCOS). Methods:A retrospective cohort study was conducted to analyze the clinical data of 438 PCOS patients who underwent the first FET in our center from January 2017 to December 2021.They were divided into hormone replacement treatment group(HRT group,n=330)and GnRH-a+HRT group(down-regulation group,n=108)according to the endometrial preparation protocol.According to BMI levels,the patients were divided into normal weight group(BMI＜24 kg/m2,n=226)and overweight/obesity group(BMI≥24 kg/m2,n=2 1 2).Baseline data and clinical pregnancy outcomes were compared between the groups,and multivariate modified Poisson regression was used to analyze the factors affecting live birth and abortion. Results:The implantation rate,clinical pregnancy rate,ongoing pregnancy rate and live birth rate of down-regulation group were higher than those of HRT group,and the abortion rate was lower than that of HRT group,but the difference was not significant(P＞0.05).The overweight/obesity group had significantly higher late abortion rate than the normal weight group(12.4％ vs.5.5％,P=0.032)and significantly lower live birth rate than the normal weight group(48.6％ vs.60.6％,P=0.011).The implantation rate,clinical pregnancy rate and ongoing pregnancy rate in overweight/obesity group were lower than those of normal weight group,but there was no significant difference(P＞0.05).Modified Poisson regression analysis showed that BMI(RR=0.95,95％CI=0.93-0.98,P=0.001)and endometrial thickness(RR=1.05,95％CI=1.00-1.11,P=0.035)were independent predictors of live birth,and BMI was the risk factor of miscarriage,with an increase of 1 kg/m2 in BMI associated with 13％increase in miscarriage(RR=1.13,95％CI=1.05-1.21,P=0.002). Conclusions:For PCOS patients undergoing fresh cycle whole embryo freezing and the first FET treatment,GnRH-a pretreatment cannot improve the pregnancy outcomes.High BMI is the high-risk factor affecting live birth,suggesting that weight control may improve the pregnancy outcomes of frozen-thawed embryo transfer in PCOS patients.关键词
多囊卵巢综合征/冻融胚胎移植/体质量指数/降调节/活产/流产Key words
Polycystic ovary syndrome/Frozen-thawed embryo transfer/Body mass index/Down-regulation/Live birth/Abortion分类
医药卫生引用本文复制引用
王睿,刘彬,徐琳..GnRH-a预处理和BMI对PCOS患者首次冻融胚胎移植周期妊娠结局的影响[J].生殖医学杂志,2023,32(12):1798-1805,8.基金项目
哈尔滨医科大学儿科学专项基金(31021220014) （31021220014）
