PPOS方案促排卵全胚冷冻患者首次冻融胚胎移植时机对临床及围产期结局的影响:一项倾向性评分匹配研究  

Effect of timing of first frozen-thawed embryo transfer on clinical and perinatal outcomes in whole embryo cryopreservation patients with PPOS protocol:a propensity score matching study

作　　者：杨如雪 黄江笛 张彩华 徐影 张亚 李丹阳 张俊韦 任炳楠 胡继君[1] 管一春[1] 孙丽君[1] Yang Ruxue;Huang Jiangdi;Zhang Caihua;Xu Ying;Zhang Ya;Li Danyang;Zhang Junwei;Ren Bingnan;Hu Jijun;Guan Yichun;Sun Lijun(Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院生殖医学中心,郑州450052

出　　处：《中华生殖与避孕杂志》2023年第11期1158-1162,共5页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨应用醋酸甲羟孕酮(medroxyprogesterone acetate,MPA)行高孕激素状态下促排卵(progestin primed ovarian stimulation,PPOS)方案,全胚冷冻患者首次冻融胚胎移植(frozen-thawed embryo transfer,FET)时机对临床结局的影响。方法回顾性队列研究分析2015年1月至2021年11月期间在郑州大学第三附属医院生殖医学中心行PPOS方案促排卵全胚冷冻后首次FET患者的临床资料,根据其促排卵周期取卵日与首次FET日的时间间隔分为两组,A组为取卵后首次月经周期进行移植(时间间隔≥24 d且<45 d,n=80),B组为取卵后至少间隔1个月进行移植(时间间隔≥45 d,n=1040)。经倾向性评分匹配(propensity score matching,PSM)后,比较两组患者一般资料、临床促排卵情况、胚胎实验室指标、首次FET周期相关指标、临床及围产期结局。结果匹配前A组年龄[38(35,41)岁]明显高于B组[37(32,40)岁,P=0.020]。PSM后A组为80个周期,B组为240个周期。匹配后两组患者一般资料比较差异均无统计学意义(均P>0.05);两组促排卵周期资料、胚胎实验室指标、临床妊娠率、活产率及围产期结局差异均无统计学意义(均P>0.05)。结论相比于取卵后至少间隔1个月行FET,PPOS方案取卵后首次月经来潮周期行FET并不会影响临床及围产期结局。可根据患者情况考虑在取卵后尽早行FET,以缩短患者到达首次活产的时间。Objective To investigate the timing of the first frozen-thawed embryo transfer(FET)on clinical and perinatal outcomes in whole embryo freezing patients,who used the medroxyprogesterone acetate(MPA)in progestin primed ovarian stimulation(PPOS).Methods A retrospective cohort study was conducted to analyze the clinical data of patients with the first FET after ovulation induction by PPOS protocol in Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from January 2015 to November 2021.According to the time interval between the day of oocytes retrieved and the day of the first FET in the ovulation induction cycle,they were divided into two groups.Group A:transplantation was performed during the first menstrual cycle after oocyte retrieval(time interval≥24 d and<45 d,n=80),group B:transplantation was performed at least one month apart after oocytes retrieved(time interval≥45 d,n=1040).After propensity score matching(PSM),the general data,clinical excretion promotion,embryo laboratory indicators,indicators related to the first FET cycle,clinical and perinatal outcomes were compared between the two groups.Results Before PSM,the age of group A was significantly higher than that of group B[38(35,41)years vs.37(32,40)years,P=0.020].After PSM,there were no significant differences in general data,ovulation induction cycle data,embryo laboratory indicators,clinical pregnancy rate,live birth rate and perinatal outcomes between the two groups(all P>0.05).Conclusion Compared with FET at least one month after oocytes retrieval,FET during the first menstrual cycle after PPOS does not affect clinical or perinatal outcomes.FET can be performed as early as possible after oocytes retrieval according to the condition of patients to shorten the time to reach their first live birth.

关 键 词：高孕激素状态下促排卵 冻融胚胎移植 移植时机 临床妊娠率 围产期结局 

分 类 号：R714.8[医药卫生—妇产科学]