Analysis Of Factors Affecting Clinical Pregnancy Outcome And Pregnancy Complications Outcome Of Frozen-thawed Embryo Transfer

Assisted reproductive technology(ART)has been widely used in the treatment of infertility patients,and its safety has been increasingly concerned by both doctors and patients.Frozen-thawed embryo transfer(FET),which can significantly reduce the risk of ovarian hyper-stimulation syndrome and increase the cumulative pregnancy rate,has increased significantly in applications.Embryo implantation is related with many factors such as age,embryo,endometrium,immunity,and etc,especially determined by the embryo and the receptivity of endometrial.With the development of technology,high-quality embryos are transferred every cycle therefore most of embryo implantation failures are caused by endometrial factors.It was reported that abnormal endometrial peristaltic waves caused by uterine junctional zone are related to embryo implantation failure.The uterine junctional zone is a special structure between the endometrium and the myometrium,changes periodically with the menstrual cycle.The thickness of the uterine junctional zone may be related to the clinical pregnancy,pregnancy complications,live birth of ART.FET pregnancy includes clinical pregnancy,pregnancy maintain and safely deliver a healthy babies.How to ensure the safe and healthy delivery of patients without pregnancy complications is the common concern for doctors and patients.This topic prospectively analyzes the factors that affect the pregnancy,retrospectively analyzes the factors that affect the pregnancy complications,and discusses how to guide FET patients to achieve a successful pregnancy and safely delivery a healthy baby without affecting pregnancy rate.Part 1:Correlation analysis of uterine junctional zone and pregnancy outcome in patients with frozen-thawed embryo transferObjectiveTo analyze the FET cycle pregnancy outcomes,live birth outcomes and neonatal weight-related factors through three-dimensional vaginal ultrasound measurement of the thickness of the uterine band before the embryo transfer and other clinical data,to explore the role of the JZ in assessing the clinical pregnancy outcome of FET,and to provide more clinical evidence for the clinical prognosis of patients.MethodCollect the clinical data and the thickness of JZ before the day of embryo transfer 274 cycles who performed FET at the Reproductive Medicine Center of the First Affiliated Hospital of Zhengzhou University from November 1,2018 to December 31,2018.Pregnancy outcome follow-up deadline is November 30,2019.ResultA total of 274 frozen-thawed embryo transfer cycles were enrolled,including 153 clinical pregnancy cycles and 96 live birth cycles.The thickness of JZ is negatively correlated with the clinical pregnancy outcome.The probability of pregnancy in the JZ?2.45mm group is lower than that in the JZ<2.45mm group(aOR:0.428,P<0.05).Age is an independent risk factor for miscarriage,and the chance of miscarriage increases with age(aOR:1,140,P<0.05).The number of transferred embryos is an independent risk factor for low birth weight of newborns,and the incidence of low birth weight increases with the increase of the number of transferred embryos(aOR:13.935,P<0.05).ConclusionThe thickness of the JZ is negatively related to the clinical pregnancy outcome and not related to the live birth outcome of FET patients.It is an independent risk protective factor affecting clinical pregnancy.For childbearing women,three-dimensional vaginal ultrasonography can be used to measure the thickness of JZ before the day embryo transfer to provide a prognostic guide for FET.Age is an independent factor that affects miscarriage rates so it's suggested women of childbearing age to delivery in time to reduce the occurrence of adverse pregnancy outcomes.The number of embryos transferred is an independent risk factor for low birth weight of newborns,and individualized programs should be developed according to the patients' conditions.Part2:Analysis factors affecting pregnancy complications of frozen-thawed embryo transferObjectiveTo investigate the influencing factors of FET pregnancy complications,evaluate the impact of endometrial preparation programs of FET on complication,and analyze other factors affecting pregnancy complications.Aim to provide reasonable preparation guidance for FET pregnant patients to reduce the incidence of complications during pregnancy for safe and healthy delivery of FET patients.MethodCollecte the clinical data,pregnancy outcomes and delivery conditions of patients who underwent FET in the First Affiliated Hospital of Zhengzhou University from October 1,2016 to October 31,2019.A multifactor logistic regression model was used to analyze the influencing factors of each complication.Result1.Among the 6370 cases of FET patients with delivery,1112(17.46%)cases had premature delivery,141 cases(2.21%)had gestational diabetes mellitus,338 cases(5.31%)had hypertension during pregnancy,and 203 cases(3.19%)had premature rupture of membranes,35 cases of placenta previa(0.55%)and 7 cases of stillbirth(0.11%).2.The infertility factors,endometrial thickness,number of embryos transfer,endometrium preparation program and multiple pregnancy rate of hypertensive disorder complicating pregnancy group were significantly different from the control group(P<0.05).Multivariate logistic regression analysis showed that BMI,artificial cycle,down regulated artificial cycle,multiple pregnancy and polycystic ovary syndrome were independent risk factors for hypertensive disorder complicating pregnancy(P<0.05).3.The age,E2,infertility type,infertility factors,BMI and the number of embryos transfer of the GDM group were significantly different from the non-GDM group(P<0.05).Multivariate logistic regression analysis showed that age and BMI were independent risk factors for GDM(P<0.05).4.The rate of hypertensive disorder complicating pregnancy and multiple pregnancies in the premature rupture membrane group were significantly different from the non-premature rupture membrane group(P<0.05).Multivariate logistic regression analysis showed that both of them were independent risk factors for premature rupture membrane(P>0.05).5.The age,FSH,infertility factors,BMI,intimal thickness,number of transferred embryos,endometrium preparation program,hypertensive disorder complicating pregnancy,premature rupture of membranes and multiple pregnancy of the preterm were significantly different from non-premature groups(P<0.05).Multivariate logistic regression analysis showed that down regulated artificial cycle,premature rupture of membranes and multiple pregnancies were independent risk factors for preterm birth(P<0.05),and BMI was an independent protective factor for preterm birth(P<0.05).ConclusionMultiple pregnancy and endometrial preparation programs are important factors affecting pregnancy complications in patients with frozen-thawed embryo transfer.Choosing natural cycle to prepare endometrium and using single pregnancy to reduce the impact of pregnancy complications to ensure pregnant patients safely deliver healthy babies.