ABSTRACT
ObjectiveTo investigate the clinical efficacy of oral dydrogesterone alone for luteal phase support in natural cycle frozen-thawed embryo transfer （NC-FET）. MethodsThe clinical data of 1 530 NC-FET cycles enrolled in our Reproductive Center from January 2019 to September 2021 were retrospectively analyzed. According to different luteal support protocols， the patients were divided into oral dydrogesterone alone （group A， n=524）， vaginal progesterone soft capsules （group B， n=401） and vaginal progesterone soft capsules combined with dydrogesterone （group C， n=605）. The clinical outcomes and cost-effectiveness ratio were compared among the three groups. The primary outcome was live birth rate. ResultsThe live birth rate was 43.13% （226/524） in group A， 39.15% （157/401） in group B， and 42.64% （258/605） in group C. There was no statistical difference among the three groups （P > 0.05）. No statistical difference was observed in the HCG positive rate， implantation rate， biochemical pregnancy rate， clinical pregnancy rate， spontaneous miscarriage rate， ectopic pregnancy rate， twin delivery rate， premature delivery rate and newborn weight among the three groups （P>0.05）. Logistic regression analysis revealed that the three luteal support regimens did not affect live birth rate. Pharmacoeconomic analysis showed that taking group B as a reference， the cost increased by 19 227.30 yuan for every 1% increase in live birth rate in group A. ConclusionsIn NC-FET cycle， oral dydrogesterone alone can achieve the same clinical outcomes as vaginal progesterone soft capsules and vaginal progesterone soft capsules combined with dydrogesterone. Compared with that of progesterone soft capsules， the cost of oral dydrogesterone alone is increased， a large sample and multicenter prospective study is needed to further confirm our results.
ABSTRACT
Objective:To explore the factors affecting the pregnancy outcome of frozen-thawed embryo transfer (FET) in endometriosis (EMT) patients in order to provide reference for the clinical selection of FET strategies. Methods:A total of 329 EMT patients who received blastocyst FET at the Reproductive Medicine Center, Department of Obstetrics & Gynecology, The 900th Hospital of the Joint Logistics Support Force, PLA, from Jan. 2015 to Dec. 2017 were analyzed retrospectively. The patients were divided into three groups according to endometrial preparation protocols, ages, and endometrial thickness on the day of progesterone conversion, respectively. By endometrial preparation protocols, the three groups included gonadotropin-releasing hormone agonist (GnRH-a) down-regulation+ hormone replacement therapy (HRT) group (GnRH-a+HRT group, A1 group, n=138), HRT group (B1 group, n=52), and natural cycle (NC) group (C1 group, n=139). By ages, the three groups included 35 years old group (C2 group, n=59). By endometrial thickness on the day of progesterone conversion, the three groups included 12 mm group (C3 group, n=37). The differences in pregnancy outcomes among EMT patients with blastocyst FET were compared under different grouping factors. Results:The endometrium of A1 group was significantly thicker than that of B1 group (P=0.041), the implantation rate and clinical pregnancy rate of B1 group were significantly higher than those of C1 group (P=0.000, P=0.003). Compared with A1 group, the implantation rate of B1 group was significantly higher (P=0.023), while it was significantly lower in group C1 (P=0.027). The abortion rate of A2 group was significantly higher than that of B2 group (P=0.007). Compared with A3 group, the implantation rate of B3 group was significantly higher (P=0.041), while it was significantly lower in C3 group (P=0.026). Conclusion:HRT endometrial preparation protocol for EMT patients with blastocyst FET can improve the implantation rate and clinical pregnancy rate, and reduce the abortion rate and ectopic pregnancy rate, which may be an economical and efficient endometrial preparation protocol in clinical.
ABSTRACT
Objective To investigate how to optimize the protocol of embryo cryopreservation to improve the success of frozen-thawed embryo transfer (FET), reduce multiple pregnancy rate and increase the cumulative pregnancy rate from one oocyte retrieval process. Methods The clinical data of 1 166 FET cycles were retrospectively analyzed and separated into different groups:445 for vitrification and 721 for slow-freezing. The vitrification group was divided into single embryo (28 cy?cles), double embryos (71 cycles) and triple embryos (346 cycles). 0-1 optimal embryo was called O0-1 group (235 cycles), 2 optimal embryos were called O2 group (80 cycles), 3 optimal embryos were called O3 group (130 cycles). The difference preg?nancy outcomes (implantation rate, clinical pregnancy, abortion rate and live-birth rate) were compared between groups. Results (1) There were significantly higher embryo survival rate(98.3%vs 73.1%), embryo recovery rate without damaging (83.3%vs 62.1%), implantation rate(36.8%vs 29.9%), clinical pregnancy(57.1%vs 44.0%) and live-birth rate(47.9%vs 34.5%) in vitrification group than those of slow freezing group(P0.05). Conclusion Vitrification technology can improve the clinical pregnancy and live-birth rate, and decrease multiple preg?nancy rate. Two optimal embryos in one tube are supposed to be the preferred method for embryo cryopreservation.