| Polycystic ovary syndrome(PCOS)is a common endocrine and metabolic disorder caused by genetic and environmental factors,with a high incidence of 20~35 years old in women of childbearing age,and is the most common cause of anovulation infertility.In the process of in vitro fertilization and embryo transplantation or intracytoplasmic sperm injection(IVF-ET/ICSI),PCOS patients because of its ovarian hyperresponsiveness,in or after controlled ovarian hyperstimulation and embryo transplantation,the incidence of ovarian hyperstimulation syndrome(OHSS)and fresh embryo transfer cycle cancellation rate are higher,often require with the aid of embryo freezing and freeze-thaw embryo transfer(FET)technology to increase the cumulative pregnancy rate,reducing frequency of controlled ovarian hyperstimulation and the economic burden of patients.There are many factors that influence the outcomes of FET cycle,such as the age of the woman,the type and quality of the transplanted embryo,the thickness and morphology of the endometrium,and its synchronization with embryonic development.The choice of endometrial preparation protocols is the key link affecting the FET cycle outcomes.Although domestic and foreign scholars have conducted many basic and clinical research on this issue,they have not reached a unified conclusion.For the PCOS less than 35 years old,does different endometrial preparation protocols have an impact on the clinical outcome of the FET cycle when the quality of the transplanted embryo is controlled to be a high-quality embryo or a high-quality blastocyst? To solve this problem,clinical data of 2,260 FET cycles in 1,429 patients were retrospectively analyzed in this paper,in order to find the optimal endometrial preparation protocols suitable for the freeze-thaw embryo transfer cycle in polycystic ovary syndrome patients with age less than 35 years,so as to guide clinical decisions.ObjectiveTo explore the optimal endometrial preparation program for frozen-thawed embryo transfer in patients with polycystic ovary syndrome with age less than 35 years.Materials and Methods1.Subjects:Retrospective analysis of clinical data of PCOS patients aged less than 35 years old who underwent IVF/ICSI-FET treatment at the Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from July 1,2010 to August 31,2017.2.Inclusion and exclusion criteriainclusion criteria:(1)age < 35 years old;(2)in line with Rotterdam diagnostic criteria,diagnosed as PCOS;(3)there were indications of IVF/ICSI;(4)at least one high quality embryo or high quality blastocyst is transplanted.Exclusion criteria :(1)chromosome abnormalities of either party in the couple;(2)three consecutive transplants(at least four quality embryos or quality blastocysts)or more without pregnancy;(3)patients with organic lesions such as ovarian cyst,hydrosalpinx,endometriosis,adenomyosis,uterine fibroids,uterine deformity(unicorn uterus,mediastinal uterus,etc.);(4)donor egg and preimplantation genetic diagnosis or preimplantation genetic screening(PGD/PGS)assisted pregnancy patients.3.Grouping: According to the above criteria,2260 FET cycles of 1429 patients were included.According to different endometrial preparation programs,clinical data of all cycles were divided into low-dose HMG ovulation induction group low-dose HMG ovulation induction group(n=174),LE ovulation induction group(n=642)and artificial cycle group(n=1444).Compare the clinical outcomes of different endometrial preparation protocols for the FET cycle.At the same time,according to FET pregnancy outcome,all clinical data were divided into clinical pregnancy group(n=1349)and non-clinical pregnancy group(n=911).After multivariate logistic regression correction of other confounding factors affecting clinical pregnancy rate,the effect of endometrial preparation protocols on clinical pregnancy rate was analyzed.4.Statistical methods: SPSS21.0 software was used for statistical analysis.Kolmogorov-smirnov test was used to test the normality of continuous variable data.The measurement data were described by mean±standard deviation(±s),the sample mean was compared by one-way ANOVA,and the comparison between groups used LSD-t test.The count data is described by percentage(%),and the sample rate is compared by row x list chi-square test.Univariate analysis of continuous variables using two independent sample t-tests,and univariate analysis of categorical variables using a four-square table chi-square test;The multivariate analysis of the correction of confounding factors was performed using a binary logistic regression model;the test level was ?=0.05,and the comparison test level of the three groups of sample rates was ?=0.017.Results1.The BMI of the patients in the low-dose HMG ovulation induction group was significantly lower than that in LE ovulation induction group and the artificial cycle group(22.00±1.84 VS.22.59±2.92 and 22.72±3.16;P = 0.366),but there was no statistically significant difference between the other two groups.There were no statistical differences in other baseline data for the three groups of patients.2.The number of transplanted embryos(1.61±0.52 VS.1.52±0.54 and 1.47±0.50;P = 0.000)and the endometrial thickness at the day of transplantation(10.00±1.35 VS.9.68±1.56 and 9.61±1.40;P = 0.000): the artificial cycle group was significantly higher than LE ovulation induction group and the low-dose HMG ovulation induction group,and the difference between the latter two groups was not statistically significant.There were statistically significant differences among the three groups(P<0.05),but no statistically significant differences between any two of the three groups(P?0.017).3.There was no significant difference in implantation rate,ectopic pregnancy rate,multiple pregnancy rate,abortion rate,preterm delivery rate and delivery mode among the three groups(P>0.05).The clinical pregnancy rate(49.4% VS.59.8% and 60.9%;P = 0.015)and live birth rate(42.0% VS.52.3% and 52.4%;P = 0.031)of the low-dose HMG ovulation induction group were significantly lower than those of LE ovulation induction group and the artificial cycle group(P<0.017),and there was no significant difference between the latter two groups(P>0.017).4.After adjusting the confounding factors by Logistic regression analysis,the effect of endometrial preparation protocols on clinical pregnancy was statistically significant(P<0.05).Compared with low-dose HMG ovulation induction group,the OR value of the LE ovulation induction group(OR=1.657;95%CI:1.268-1.455)and the artificial cycle group(OR=1.607;95%CI:1.153-2.240)were greater than 1.In addition,the age of the woman,the endometrial thickness on the day of transplantation,the number of transplanted embryos and the type of embryos were all significant factors affecting the clinical pregnancy of these patients.Among them,compared with age <28 years,the OR value of female age ? 28 years(OR=0.774;95% CI:0.640-0.937)was less than 1;The OR value of intimal thickness(OR=1.231;95%CI:1.152-1.315)and the number of transplanted embryos(OR=1.760;95%CI:1.436-2.159)were greater than 1.Compared with the embryo at cleavage stage,the OR value of blastocyst transfer(OR=3.136;95%CI:2.507-3.922)was greater than 1.All of the differences were statistically significant(P<0.05).Conclusions1.For the selection of endometrial preparation protocols of frozen embryo transfer cycles in PCOS patients younger than 35 years old,the artificial cycle program and the LE ovulation induction program are superior to the low-dose HMG ovulation induction program.Clinicians can individually select according to the patient's condition.2.Female age,endometrial thickness on the day of transplantation,number of transplanted embryos and embryo type were all significant influencing factors for clinical pregnancy of PCOS patients aged < 35 years with FET cycle.3.Compared with age <28 years,PCOS patients with age ? 28 had a lower likelihood of clinical pregnancy;blastocysts were more likely to receive clinical pregnancy than cleavage embryo transfer. |
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