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

目的探讨长效促性腺激素释放激素激动剂(GnRH-a)预处理及体质量指数(BMI)对多囊卵巢综合征(PCOS)全胚冷冻患者首次冻融胚胎移植(FET)周期妊娠结局的影响。方法回顾性队列研究分析2017年1月至2021年12月在本中心新鲜周期全胚冷冻行首次FET助孕的438例PCOS患者的临床资料。根据内膜准备方案分为激素替代组(替代组,330例)和降调节+激素替代组(降调组,108例);根据BMI分为正常体重组(BMI<24 kg/m 2,226例)和超重/肥胖组(BMI≥24 kg/m 2,212例)。比较各组患者的基线资料和临床妊娠结局,并通过多因素修正泊松回归分析影响活产和流产的因素。结果降调组的胚胎植入率、临床妊娠率、持续妊娠率和活产率有高于替代组的趋势,而流产率有低于替代组的趋势,但差异均无统计学意义(P>0.05);超重/肥胖组的晚期流产率显著高于正常体重组(12.4%vs.5.5%,P=0.032),活产率显著低于正常体重组(48.6%vs.60.6%,P=0.011);超重/肥胖组的胚胎植入率、临床妊娠率、持续妊娠率均低于正常体重组,但差异均无统计学意义(P>0.05)。多因素修正泊松回归分析显示,BMI[RR=0.95,95%CI(0.93,0.98),P=0.001]和子宫内膜厚度[RR=1.05,95%CI(1.00,1.11),P=0.035]是活产的独立影响因素;BMI也是流产的独立影响因素,BMI每增加1 kg/m 2,流产几率上升13%[RR=1.13,95%CI(1.05,1.21),P=0.002]。结论对于新鲜周期全胚冷冻、首次行FET治疗的PCOS患者,GnRH-a预处理并不能明显改善妊娠结局;高BMI是影响活产的高危因素,控制体质量可以改善PCOS患者冻融胚胎移植的妊娠结局。

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/m 2,n=226)and overweight/obesity group(BMI≥24 kg/m 2,n=212).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/m 2 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.