| Research BackgroundIn recent years,with the development of high-resolution imaging,more and more patients with adenomyosis have been diagnosed.The prevalence of adenomyosis in the population is about 5%-70%.The prevalence rate of adenomyosis was about 6.9%-34.3%among the infertile women who underwent IVF.After ultrasound screening,the prevalence of adenomyosis is about 24%.Infertility caused by adenomyosis,can try a variety of methods of treatment,young and assessed no other causes of infertility patients,can naturally try pregnancy.If the natural test pregnancy has not been pregnant for more than one menstrual cycle or adenomyosis is serious,you can choose drugs or nursing surgery.If we expect to get pregnant patients in the short term,we can use assisted reproductive technology(Art)directly.In recent years,the application of minimally invasive interventional surgery(uterine artery embolization),MRI guided focused ultrasound ablation and other new methods are gradually emerging,but the effect is not clear,which needs to be further confirmed by evidence-based medicine research.Among them,art is the recommended way to help pregnancy.In the ovulation induction cycle,according to the different timing of embryo transfer,there are two ways:fresh embryo transfer and frozen embryo transfer(FET).The former refers to the transfer of high-quality embryos formed by in vitro fertilization in the current menstrual cycle,while the latter refers to the culture of embryos to blastocyst stage,freezing in liquid nitrogen in the laboratory,thawing the embryos at the appropriate time,and then transferring.For patients with adenomyosis,there is no final conclusion on which one is better,fresh embryo or frozen embryo.Therefore,it is of great clinical significance to compare the effects of two transplantation methods on pregnancy outcome and obstetric outcome in order to guide patients with adenomyosis and obtain more favorable pregnancy outcome.Research purposesCompare the pregnancy outcomes and obstetric outcomes of patients with adenomyosis and infertility after fresh embryo transfer and frozen embryo transfer,and explore other alternative treatment methods to provide reference for clinical application.Research methodThe data of art patients in reproductive Hospital Affiliated to Shandong University from 2016 to 2018 were retrospectively analyzed.According to the diagnostic criteria and inclusion criteria,891 patients with adenomyosis were selected.Among them,6 patients had chromosomal abnormalities,26 patients had a history of polycystic ovary syndrome(PCOS),3 patients had more than 3 transferred embryos,8 patients had abnormal uterine structure,7 patients had uniangular and 1 patient had bigangular type,13 patients received donor eggs due to premature ovarian failure,and 21 patients had genetic diseases or suspected genetic diseases,All patients were excluded from preimplantation genetic screening(PGs).Finally,814 patients were included in the study.According to the timing of embryo transfer,they were divided into fresh embryo group(n=481)and frozen embryo group(n=333).Baseline data,controlled ovarian hyperstimulation(COH)data,pregnancy and obstetric outcomes were compared between the two groups.The main outcome measures were live birth rate,secondary observation index,biochemical abortion rate,ectopic pregnancy rate,early abortion rate,late and middle abortion rate,clinical pregnancy rate and obstetric related outcomes.These included neonatal birth weight,placenta previa incidence rate,cesarean section rate,gestational diabetes incidence rate and incidence of hypertensive disorder complicating pregnancy.Research result1.Baseline data:age of fresh embryo group(34.31)±4.41 vs 35.62 ±The results showed that the results showed that the difference between the two groups was 4.76,P<0.001,and the basic t(23.65)was lower than that of the frozen embryo group 1 12.67 vs 21.87 ± The results showed that 12.85,P=0.032)was higher than that of frozen embryo group.2.COH related data:ovarian stimulation time in fresh embryo group(11.26 ± 2.41 vs 10.46± 2.34,P<0.001),total dose of gonadotropin(GN)(2560.16)± 1129.05 vs 2230.92±1015.74,P<0.001),P level of hCG injection day(0.901)± 79.29 vs 0.507± 82.04,P<0.001),number of embryos transferred(1.80)±0.40 vs 1.12 ± zero point three two,The number of patients with super long scheme(27.4%vs 12.6%,P<0.001)was higher than that of frozen embryo group.The fresh embryo group tended to transfer the third day embryo(82.5%),and the frozen embryo group was mainly transplanted on the 5th or 6th day(69.1%/27.9%),and there was significant difference.3.Pregnancy outcome and obstetric outcome:the clinical pregnancy rate(36.0%vs 43.8%,P=0.024),living rate(19.5%vs 25.8%,P=0.034),early abortion rate(9.4%vs 16.5%,P=0.002)were lower than that of the frozen embryo group,while ectopic pregnancy rate(4.8%vs 0.6%,P=0.001)was higher than that of frozen embryo group.The age,basic t,GN time,total GN,COH plan,P level of hCG injection day,number of embryos transferred and the number of days of embryo development were corrected.No significant difference was found between the two groups in pregnancy outcome and obstetric outcome.Analysis conclusionThere was no significant difference in pregnancy outcome and obstetric outcome between the two groups.Frozen embryo transfer tends to increase live birth rate,but there is no statistical significance.Prospective cohort studies can be added in the future. |
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