Frozen-warmed blastocyst transfer after 6 or 7 days of progesterone administration: impact on live birth rate in hormone replacement therapy cycles.
黄体酮给药 6 或 7 天后冷冻温囊胚移植: 激素替代治疗周期对活产率的影响。
- 作者列表："Roelens C","Santos-Ribeiro S","Becu L","Mackens S","Van Landuyt L","Racca A","De Vos M","van de Vijver A","Tournaye H","Blockeel C
OBJECTIVE:To study the difference in live birth rate (LBR) between frozen-warmed blastocyst transfer (FET) on the 6th or the 7th day of progesterone administration in artificially prepared cycles. DESIGN:Retrospective cohort study. SETTING:Tertiary university-based referral hospital. PATIENT(S):Patients who underwent FET between December 2015 and December 2017 in a hormone replacement therapy cycle (HRT). INTERVENTION(S):Group A included all eligible patients who underwent transfer of a vitrified-warmed blastocyst on the 6th day of progesterone administration; group B included patients who underwent blastocyst transfer on the 7th day of progesterone. The artificial HRT protocol in this study consisted of estrogen administration at a dose of 2 mg twice daily for 7 days followed by 2 mg three times daily for 6 days and micronized vaginal progesterone 200 mg three times daily from an adequately considered endometrial thickness onward. MAIN OUTCOME MEASURE(S):Live birth rate. RESULTS:The study included 619 patients, 346 in group A and 273 in group B. The LBRs were comparable between both groups (36.6% for group A and group B), even after adjustment for confounding factors (adjusted odds ratio 1.073, 95% confidence interval 0.740-1.556). Subgroup analysis revealed significantly higher miscarriage rates for day 6 blastocysts transferred on the 6th day of progesterone supplementation compared with transfer on the 7th day of progesterone supplementation (50.0% versus 21.4%, respectively). Additionally, there was a tendency toward a higher LBR when the 7-day progesterone supplementation protocol was used for transfer of a day 6 blastocyst (21.5% and 35.5% for group A and group B, respectively). CONCLUSION:Warmed blastocyst transfer on the 6th compared with the 7th day of progesterone administration in an HRT cycle results in similar LBR. Subgroup analysis of day 6 blastocysts showed significantly higher miscarriage rates when FET was performed on the 6th day of progesterone administration.
目的: 研究在人工制备的周期中，黄体酮给药第 6 天或第 7 天冷冻-温囊胚移植 (FET) 活产率 (LBR) 的差异。 设计: 回顾性队列研究。 单位: 以三级大学为基础的转诊医院。 患者: 2015 年 12 月至 2017 年 12 月期间在激素替代治疗周期 (HRT) 中接受 FET 的患者。 干预 (S): A 组包括所有符合条件的患者，这些患者在黄体酮给药的第 6 天接受了玻璃化温囊胚的移植; B 组包括黄体酮第 7 天进行囊胚移植的患者。这项研究中的人工 HRT 方案包括雌激素给药，剂量为 2 mg，每日两次，持续 7 天，然后是 2 mg，每日三次，持续 6 天，以及微粒化阴道孕酮 200 mg，持续 3 次。每日从充分考虑的子宫内膜厚度开始。 主要结局指标: 活产率。 结果: 研究共纳入 619 例患者，A 组 346 例，B 组 273 例。即使在校正混杂因素 (校正比值比 36.6%，1.073 置信区间 95%-0.740) 后，两组间的 lbr 也具有可比性 (A 组和 B 组为 1.556)。亚组分析显示，与补充黄体酮 50.0% 天的转移相比，补充黄体酮 21.4% 天转移的天囊胚的流产率显著较高 (分别为和)。此外，当使用 7 天孕酮补充方案移植 6 天囊胚时，有更高 LBR 的趋势 (a 组和 B 组分别为 21.5% 和 35.5%,分别)。 结论: 在 HRT 周期中，与孕激素给药第 7 天相比，第 6 天的温热囊胚移植产生了相似的 LBR。第 6 天囊胚的亚组分析显示，在孕酮给药第 6 天进行 FET 时，流产率显著较高。
METHODS:BACKGROUND:Controlled ovarian stimulation (COS) has a negative effect on the endometrial receptivity compared with natural menstrual cycle. Whether it's necessary to postpone the first frozen embryo transfer (FET) following a freeze-all strategy in order to avoid any residual effect on endometrial receptivity consequent to COS was inconclusive. OBJECTIVE:The purpose of this retrospective study was to explore whether the delayed FET improve the live birth rate and neonatal outcomes stratified by COS protocols after a freeze-all strategy. METHODS:A total of 4404 patients who underwent the first FET cycle were enrolled in this study between April 2014 to December 2017, and were divided into immediate (within the first menstrual cycle following withdrawal bleeding) or delayed FET (waiting for at least one menstrual cycle and the transferred embryos were cryopreserved for less than 6 months). Furthermore, each group was further divided into two subgroups according to COS protocols, and the pregnancy and neonatal outcomes were analyzed between the immediate and delayed FET following the same COS protocol. RESULTS:When FET cycles following the same COS protocol, there was no significant difference regarding the rates of live birth, implantation, clinical pregnancy, multiple pregnancy, early miscarriage, premature birth and stillbirth between immediate and delayed FET groups. Similarly, no significant differences were found for the mean gestational age, the mean birth weight, and rates of low birth weight and very low birth weight between the immediate and delayed FET groups. The sex ratio (male/female) and the congenital anomalies rate also did not differ significantly between the two FET groups stratified by COS protocols. CONCLUSION:Regardless of COS protocols, FET could be performed immediately after a freeze-all strategy for delaying FET failed to improve reproductive and neonatal outcomes.
METHODS:OBJECTIVE:To evaluate the effect of oral diosmin on the incidence and severity of ovarian hyperstimulation syndrome (OHSS) and explore the value of diosmin in preventing and treating OHSS. METHOD:A retrospective study of women attending a reproductive center in Guangzhou, China, between September and December 2016. The inclusion criterion was previous cancellation of embryo transfer after oocyte retrieval during IVF owing to a high risk of OHSS. The women were divided into two groups depending on whether they received oral diosmin (1000 mg twice daily for 10 days) after oocyte retrieval (diosmin group) or not (control group). Apart from diosmin, both groups underwent the same treatment. Baseline information and data related to OHSS were compared. RESULTS:Overall, 146 women were included: 74 in the diosmin group and 72 in the control group. The incidence of moderate-to-severe OHSS in the diosmin and control groups was 5/74 (6.2%) and 14/72 (13.4%), respectively (P=0.027). The control group included four cases of paracentesis due to ascites; there were no cases of paracentesis or severe OHSS in the diosmin group. CONCLUSION:Oral administration of diosmin effectively reduced both the incidence of moderate-to-severe OHSS and the severity of OHSS among high-risk women.
METHODS::Recurrent implantation failure (RIF) remains a clinical dilemma. Helium-Neon (He-Ne) laser irradiation has recently become more popular under certain clinical conditions. Given the unique therapeutic effects, we were interested in determining whether pretreatment with He-Ne laser irradiation prior to frozen-thawed embryo transfer (FET) would improve the microcirculation and cause the release of growth factors and cytokines, thus improving endometrial receptivity and the clinical pregnancy rates. Patients chose for themselves whether to proceed with (n = 29) or without (n = 31) pretreatment with He-Ne laser irradiation prior to FET. The clinical pregnancy rate (37.9%) and implantation rate (20.3%) were higher in the laser-treatment group than in the control group (35.5% and 15.9%, respectively, p = .844 and .518, respectively). The live birth rate was higher in the laser-treatment group (27.6% vs. 25.8%, respectively, p = .876) and the miscarriage rate was lower in the laser-treatment group (18.2% and 27.3%, respectively, p = .611). No side effects or complications from laser irradiation were encountered in patients who received the laser treatment. We concluded that pretreatment with He-Ne laser prior to FET may be an alternative choice for RIF-affected women; however, additional well-designed prospective studies are necessary to determine the precise clinical value of this treatment.