| BackgroundFrozen embryos have effectively solved the problem of preserving and utilizing the remaining embryos after fresh embryo transfer in assisted reproductive technology(ART)and have enabled preimplantation genetic testing(PGT).Frozen embryo transfer not only increases the cumulative pregnancy rate per egg retrieval cycle and greatly reduces the risk of ovarian hyperstimulation syndrome(OHSS),but also increases the clinical pregnancy rate of FET as vitrification freezing techniques mature.The advantages of frozen embryo transfer have led many fertility centers to implement an all-embryo freezing strategy,and as a result there is a growing interest in pregnancy outcomes and maternal and infant complications of frozen embryo transfer.Endometrial preparation is required prior to frozen embryo transfer,and in addition to natural cycle protocols,ovulation-promoting cycles and hormone replacement therapy both mimic the changes in estrogen and progesterone levels around the time of ovulation during the menstrual cycle.More recent studies in the literature have examined whether the FET endometrial preparation protocol influences pregnancy and maternal and neonatal outcomes.In patients with ovulation inductions,there are often problems with impaired egg development,thin endometrium,or failure of other regimens.Ovulation induction for endometrium has similar phases to super-controlled ovulation promotion,ovulation induction,and also increased luteal support after ovulation,with problems of slightly more frequent patient visits and potentially narrower graft window times compared to the other two regimens.Clinically,it is common that after ovulation promotion and ovulation induction,patients do not ovulate on schedule and have a rapid increase in progesterone,thus resulting in the narrowing of the transplantation window,possible inaccurate transplantation projection time,which affects pregnancy outcome,or cancellation of the cycle,which increases the time and financial burden on the patient.Therefore,this study aims to provide clinicians with more evidence-based medical evidence by analyzing data to reduce the unintended FET cycle cancellation rate and reduce the cost of pregnancy assistance for patients while obtaining a more desirable outcome.ObjectiveTo investigate the difference in pregnancy outcome between frozen-thawed embryo transfer in non-ovulatory patients and normal ovulatory patients in ovulation induction FET;And to explore the factors associated with live birth outcome in ovulation induction FET.MethodsThe clinical information of patients who underwent FET with ovulation promoting cycles in Hospital for Reproductive Medicine Affiliated to Shandong University from January 2017 to December 2021 was retrieved and screened according to the inclusion and exclusion criteria.1291 FET cycles meeting the criteria were screened.and the cycles meeting the criteria were divided into two groups according to whether they ovulated or not,group A(non-ovulation in ovulation cycles,addition of estrogen and progesterone to the regular drug regimen,and luteal support after transplantation,71 cycles),and group B(normal ovulation in the ovulation induction,regular luteal support after transplantation,1220 cycles).Due to the excessive difference in the amount of data between the two groups,propensity matching(1:2)was performed to equalize the final grouping of 68 cycles in group A(non-ovulation in ovulation cycles,addition of estrogen and progesterone to the regular drug regimen,and luteal support after transplantation)and 136 cycles in group B(normal ovulation in the ovulation induction,regular luteal support after transplantation).The basic clinical characteristics and pregnancy outcomes were analyzed and compared between the two groups.The influencing factors associated with live birth outcomes were also analyzed by binary Logistic regression.ResultsThe differences in baseline information between the two groups were not statistically significant(P<0.05)due to prior propensity-matched equilibrium for groups A and B.Ovulation was different between the two groups in this study,and pre transplant E2 levels were statistically significant in both groups(P=0.002).The pre-transplant E2 level in group A was(179.716±190.912)pg/ml,which was lower than group B(203.973±194.534)pg/ml.the biochemical pregnancy rate in group A was 64.7%(44/68)and slightly higher in group A(64.7%)than in group B(64.0%);the clinical pregnancy rate in group A(57.4%)was higher than in group B(53.7%):the miscarriage rate in group A(20.5%)was slightly higher than that in group B(17.8%),and the live birth rate in group A(44.1%)was lower than that in group B(46.2%),with no statistically significant differences in any of the major pregnancy outcomes between the two groups.The basic conditions of pregnancy complications and newborns in patients who obtained a live birth outcome were analyzed,and the prevalence of gestational diabetes mellitus(GDM)was 13.8%and 13.3%,and the prevalence of gestational hypertensive disorders was 8.6%and 6.7%.Respectively,between the two groups,with no statistically significant differences(P=0.745).The cesarean delivery rate was higher than the transvaginal delivery rate,with 53.3%and 58.6%between the two groups,respectively,with no statistically significant difference between the two groups(P=0.635).The number of female infants was slightly higher than that of male infants in the sex of newborns,with 56.7%and 58.6%of female infants,respectively,with no statistically significant difference(P=0.822).The weight of newborns in the two groups was 3.395+0.329 kg and 3.487+0.340 kg,with no statistically significant difference(P=0.875).With live birth outcome as the dependent variable binary Logistic regression analysis of female age(OR=0.448,95%CI0.248-0.808;P=0.008)and endometrial thickness(OR=0.401,95%CI:0.222-0.724;P=0.002).Female age,endometrial thickness were independent influencing factors.ConclusionThe judicious addition of estrogen and progesterone in the absence of ovulation in the FET of an ovulation induction can result in pregnancy outcomes comparable to those of a normal ovulation induction.In ovulation induction FET,female age and pre-transplantation endometrial thickness are independent influencing factors for live birth.Younger female age(≤35 years)and increased endometrial thickness(>0.80cm)favored live birth outcomes in FET of ovulation induction. |
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