An Analysis Of Different Means Of Preparing The Endometrium In Frozen-Thawed Embryl Transfer Cycles In The Way Of Evidence-Based Medicine

Background:To assess the effect of different means of preparing the endometrium in frozen-thawed embryo transfer cycles on reproductive outcomes in the way of evidence-based medicine,furthermore,with the data collected from our centre to compare the clinical effects on endometrial preparation in frozen-thawed embryo transfer between natural cycle and hormone replacement therapy.Methods:1.The literatures about the means of endometrial preparation in frozen-thawed embryo transfer cycles in the clinical trials,and collected the randomized controlled trials and prospectice studies which were searched from VIP,CBM,CNKI,Wanfang database,PubMed,Embase,Cochrane Library,SCIENCE Springe、Elsevier、ClinicalTrials、International Clinical Trials Registry Platform and references to enlarging the relative literatures.Then the literatures were systematically evaluated by Meta analysis with RevMan5.3.2.A retrospective matched cohort analysis of 104 cycle between January 1,2012 and December 30,2014,Who underwent natural cycle or hormone replacement therapy with regular menstruation for endometrial preparation before frozen-thawed embryo transfer(FET)in our center to compare the endometrial thickness、implantation rate、Biochemical pregnancy rate、clinical pregnancy rate、abotional rate.Result:1.A total of 10 pubilications were selected for critical appraisal to make a analysis in the way of evidence-based medicine.5 studies included of artificial cycle VS artificial cycle+GnRH-a,the implantation rate(RR=1.01,95%CI=0.80～1.28,P=0.91).clinical pregnancy rate(RR=1.12,95%CI=0.74～1.70,P=0.59).abotional rate(RR=1.44,95%CI=0.24～8.78,P=0.69),2 studies included of natrual cycle VS artificial cycle+GnRH-a,the implantation rate(RR=1.02,95%CI=0.82～1.28,P=0.83).clinical pregnancy rate(RR=1.07,95%CI=0.86～1.33,P=0.56).living birth rate(RR=1.02,95%CI=0.79～1.31,P=0.91),2 studies included of natrual cycle VS artificial cycle,.clinical pregnancy rate(RR=1.10,95%CI=0.87～1.39,P=0.44).ongoing pregnant rate(RR=1.02,95%CI=0.79～1.31,P=0.91).For all comparations,no diffenrences in the embryo implantation and clinical pregnancy rate could be found.2.It was easy to see from the data of our center,there were no significant diffenrences between the two groups with regard to the age,duration of infertility,number of embryos transfered,number of high-quality embryos(P>0.05),the endometrial thickness、implantation rate、biochemical pregnancy rate、clinical pregnancy rate、abotional rate、Ectopic pregnancy rate、live birth rate、premature birth rate、full-term birth rate were 10.24±2.01、21.31%、3.85%、26.9%、1.92%、7.69%、34.62%、9.62%、25.00%;in the group of natural cycle respectively,and were 9.10±1.26、28.21%、7.69%、46.2%、5.77%、1.92%、53.85%、21.15%、32.69%in another group of hormone replacement cycle.The comparation of implantation rate、Biochemical pregnancy rate、abotional rate、Ectopic pregnancy rate、clinical pregnancy rate、live birth rate、premature birth rate、full-term birth rate had no statistical difference(P>0.05),only endometrial thickness(10.24±2.01 VS 9.10±1.26)had statistical difference((P=0.001)between the two group.Conclusion:From the meta-analysis based on the current litertature and the result from retrospective matched cohort analysis of our center,there is no significant difference between natural cycle and hormone replacement cycle for endometrial preparation before frozen-embryo transfer.We can not tell whether it has difference between these two therapies from the way of evidence-based medicine,as there is a small number of researches on the hormone replacement cycle with normal menstruation.So,prospective randomized studies from different centers addressing this issue are needed.