基于倾向性评分匹配探讨不同超促排卵方案对子宫内膜异位症患者冻融胚胎移植的影响

Influence of different ovarian stimulation protocols on pregnancy outcomes in frozen-thawed embryo transfer cycles for patients with endometriosis based on propensity score matching

目的探讨新鲜周期不同超促排卵方案对子宫内膜异位症(EMs)患者冻融胚胎移植(FET)妊娠结局的影响。方法采用回顾性分析,收集中国人民解放军陆军第七十三集团军医院生殖中心2012年6月至2021年12月行FET治疗的1342例子宫内膜异位症患者的临床资料,年龄20~44岁。根据治疗方案分为改良长方案组(1161例)和拮抗剂方案组(181例)。使用倾向性评分匹配两组患者基线资料并比较妊娠结局。计量资料采用独立样本t检验,计数资料采用χ^(2)检验,采用多因素logistic回归分析探讨子宫内膜异位症患者冻融胚胎移植的影响因素。结果匹配前,改良长方案组临床妊娠率(50.65%,588/1161)较拮抗剂方案组(41.99%,76/181)显著升高,差异有统计学意义(χ^(2)=4.695,P=0.031);匹配后,两组临床妊娠率差异无统计学意义(P>0.05)。多因素logistic回归分析显示,年龄、移植次数、囊胚移植、移植胚胎数量及质量是子宫内膜异位症患者FET妊娠结局的独立影响因素(均P<0.05),而新鲜周期促排卵方案对其无显著影响(P>0.05)。结论新鲜周期不同超促排卵方案对子宫内膜异位症患者冻融胚胎移植结局无显著影响。

Objective To investigate the impact of different ovarian stimulation protocols in fresh cycles on the pregnancy outcomes in frozen-thawed embryo transfer(FET)for patients with endometriosis(EMs).Methods A retrospective study was conducted analyzing the clinical data of 1342 EMs patients in Reproductive Medicine Center,73rd Group Army Hospital of PLA from June 2012 to December 2021 who were 20-44 years old.They were divided into a modified long protocol group(1161 cases)and an antagonist protocol group(181 cases)according to the treatment schemes.The propensity score was used to match to the two groups'clinical characteristics,and the pregnancy outcomes were analyzed.Independent-sample t test was used for the measurement data,andχ^(2)test for enumeration data.Multivariate logistic regression was used to analyze the patients influencing factors.Results The clinical pregnancy rate in the modified long protocol group was significantly higher than that in the antagonist protocol group before propensity score matching[50.65%(588/1161)vs.41.99%(76/181);χ^(2)=4.695,P=0.031].After propensity score matching,there was no statistically significant difference in the clinical pregnancy rate between the two groups(P>0.05).Multivariate logistic regression analysis showed that age,number of transplantation times,blastocyst transfer,and number and quality of embryos transfer were the independent factors affecting the pregnancy outcomes of FET for patients with EMs(all P<0.05).However,the ovarian stimulation protocol in fresh cycles did not have significant influence on the outcomes(P>0.05).Conclusion Different ovarian stimulation protocols in fresh cycles does not affect the pregnancy outcomes of frozen-thawed embryo transfer for patients with EMs.